hinders 'Question Comnauk 



■Essentials of 

MATERIAMEI)I€A Ml) Till 

Hf.XKY M« '{ 



SEP 8 1898 



ESSENTIALS 

OF 

Materia Medica, Therapeutics, and 
Prescription-Writing. 



Since the issue of the first volume of the 
Saunders Question=Compends, 

OVER 160,000 COPIES 

of these unrivalled publications have been sold. 
This enormous sale is indisputable evidence 
of the value of these self-helps to students 
and physicians. 



SAUNDERS' QUESTION-COMPENDS, No. 7. 

ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS., 
AND PRESCRIPTION WRITING 



ARRANGED IN THE FORM OF 



QUESTIONS AND ANSWERS 



PREPARED ESPECIALLY FOR 



STUDENTS OF MEDICINE. 



BY 

HENRY MORRIS, M.D., 

Fellow of the College of Physicians of Philadelphia; Honorary Member of the 
Altoona Academy of Medicine: Associate Member of the Association of 
Military Surgeons of the United States; Member of the American Medical 
Association, of the Pennsylvania State Medical Society, of the Philadel- 
phia County Medical Society, of the Pathological Society of 
Philadelphia; Physician to St. Joseph's Hospital. 



FIFTH EDITION, REVISED AXD ENLARGED. 



PHILADELPHIA : 

W. B. SAUNDERS, 

I 

£25 Walnut Sttoeet. i 

1898. 



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^K v 



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13653 

Entered according to Act of Congress, in the year 1898, by 

W. B. SAUNDERS. 
In the Office ot the Librarian of Congress, at Washington. 




8EP 8 - 1888 



IIVEO. 



PRESS OF 



W. B. SAUNDERS, PH1LADA. 






9to tijt pifmor^ of 
DR. THEODORE HORWITZ, 

WHOSE EARLY DEATH 

DEPRIVED THE MEDICAL PROFESSION OF AN EARNEST 

AND TALENTED WORKER, 

THIS BOOK IS AFFECTIONATELY INSCRIBED 

BY HIS FRIEND, 

THE AUTHOR. 



PREFACE TO THE FIFTH EDITION. 



In the preparation of this edition it has been the object 
of the author not only to follow closely the last edition 
of the U. S. Pharmacopoeia, but also to bring the book, 
as nearly as possible, thoroughly abreast of the times. 
Much that was obsolete has therefore been omitted, and 
many new drugs, especially among the groups of antipy- 
retics and hypnotics, have been added, while the older 
subject-matter has been carefully revised and corrected. 

In deference to the criticisms of English and Canadian 
medical journals, the dosage of each preparation has 
been expressed in the metrical weights and measures as 
well as in apothecaries' weight and wine measure. This 
change has been rendered necessary also by the adoption 
of the metrical system by the Medical Corps of the 
United States Army, many of whose officers have in the 
past used, and I hope in the future will continue to use, 
this little book for reference. 

One word in regard to former criticisms, which on the 
whole have been most kind and considerate : The author 
is criticised for his classification of medicines. He thinks, 
with Lauder Brunton, that the time has come in scientific 
medicine when an attempt at classification, however imper- 
fect and tentative, should be made, instead of giving up 
the entire subject as hopeless, and arranging the remedies 
in alphabetical order ; in which case, probably, as in a book 
before him, remedies as diverse in their effects and uses as 
croton oil, eubebs, cyanide of potassium, digitalis, elaterium, 
and ergot would follow each other, to the endless confu- 
sion of the student, who knows that the only way he can 

7 



8 PREFACE. 

master a subject thoroughly is by systematizing his knowl- 
edge and his method of study, which is hardly possible if 
he learns in succession, and without any connection with 
each other, the effects and uses of oxide of zinc, oxygen, 
pancreatin, paraldehyde and pareira, to take a few ex- 
amples of such classification at haphazard. While admit- 
ting that his classification is not free from faults, the 
author regards it as much preferable to the examples 
quoted. 

By adopting a classification based on a therapeutical 
rather than a physiological method, the entire book is a 
therapeutical index ; and while the names of diseases do 
not appear in the table of contents, it is in reality, from 
its arrangement, an index to the remedies adapted to the 
treatment of various diseased conditions. 

The author acknowledges his indebtedness to numerous 
standard text-books, as the National Dispensatory ; the 
U. S. Pharmacopoeia ; Wood's, Hare's, Lauder Brunton's, 
Foster's, and Wilson's Therapeutics ; Maisch's Organic 
Materia Medica ; Bloxam's Chemistry; Blythe on Poisons; 
as well as various medical annuals, as those of Sajous, 
Gould, the International Medical Annual ; and to writers 
in the various medical journals, whose papers, though too 
numerous to mention, form the great bulk of new matter 
in this edition. 

The author takes pleasure in thanking Dr. Henry C. 
Haden for his valuable work in gathering references and 
abstracts ; and his acknowledgments are also due to Miss 
Caroline M. Irwin for the exhaustive and thorough index, 
which he is sure will add much to the value of this edition. 

In conclusion, he renews the dedication to the memory 
of his friend, the late Dr. Theodore Horwitz, and while 
thanking the profession and critics for their kind reception 
of former editions, expresses the hope that they will find 
the present edition equally worthy of their confidence. 

HENRY MORRIS. 

813 S. 16th St., Philadelphia. 



PREFACE. 



The object of this little book is, not to replace or attempt to 
replace with the student the larger text-books on Materia Medica, 
but simply to give him, in condensed form, the principles of this 
branch of medicine, without a knowledge of which he can neither 
pass his final examinations, nor practice his profession intelligently. 

The author hopes that, if properly used, this book will be of ser- 
vice to the student and young practitioner, but he is sure, from his 
experience as a teacher, that neither this nor any other " compend " 
will suffice to form the groundwork of what is really the study of a 
lifetime — the Science of Medicine. 

In regard to the classification of drugs, he would say that this work 
was commenced before the excellent arrangement contained in the 
last edition of Prof. Wood's Therapeutics was published, and not 
being satisfied with any of the groupings which he had seen, he was 
induced to adopt a classification based on therapeutic rather than 
physiological grounds, which, however, he is pleased to think agrees 
very nearly with that of the latest edition of Wood. In conclusion 
he must acknowledge his indebtedness not only to the standard text- 
books, such as the admirable works of Wood, Bartholow, Ringer, 
Lauder Brunton and many others, but also to many writers in the 
medical journals, both of this and other countries, to whom want 

9 



10 PREFACE. 

of space has prevented him from giving due credit in the appro- 
priate place. He must also acknowledge the kindness of his friend, 
Dr. Henry D. Moore, to whom he is indebted for the preparation of 
the index. 

Believing that the critic is the best friend of the medical author, 
he will thankfully receive any criticisms or hints from either public 

or private sources. 

HENRY MORRIS. 

SIS South 16th St., Philadelphia. . 



TABLE OF CONTENTS. 



PAGES 

DEFINITIONS. — (Materia Medica, Pharmacy, Pharmacology, 
Therapeutics, Eemedies, Pharmacopoeia, Dispensatory, Official 
preparations), 17-23 

WEIGHTS AND MEASURES.— (Troy or Apothecaries' weights, 
Wine or Apothecaries' measure, Metrical or decimal system 
of weights, Tables showing the value of Apothecaries' 
weights in the metrical system, Table showing the value of 
Apothecaries' measure in the metrical system, Approximate 
measures), 23-26 

PRESCRIPTION WRITING.— (Purposes for which medicines are 
combined, Precautions to be observed in prescription writing, 
Component parts of a prescription, Method of writing a pre- 
scription, Calculation of dose, General rules for dosage), . . . 26-30 

INFLUENCES THAT MODIFY EFFECTS OF MEDICINES.— (Age, 
Sex, Idiosyncrasy, Constitution, Habitual use, Condition of 
digestive and absorbent systems, Diseases, Mode of adminis- 
tration) 30-32 

ADMINISTRATION OF MEDICINES.— (Enepidermic, Epidermic, 
Endermic, and Hypodermic methods, By the mucous mem- 
branes, By intravenous injection), 32 

CLASSIFICATION OF MEDICINES, "... 33, 34 

GROUP I.— Systemic Medicines, 35-244 

Class I. —Medicines Acting on the Body at Large, 
by their Influence on Digestion, Nutrition 
(tissue waste and repair), and Calorification, . . 35-90 
Order l.—Digestants — (Pepsin, Ingluvin, Pancreatin, 

Papain), 35-37 

Order 2.— Tonics— (Quassia, Gentian, Calnmba, Chirata, 
Serpentaria. Eucalyptus, Primus Virginiana, Anthemis, 

11 



12 TABLE OF CONTENTS. 

PAGES 

Matricaria, Eupatorium, Cascarilla, Absinthium, Cinchona 
and its alkaloids, Hydrastis, Preparations of Iron and of 
Manganese, Phosphorus, Mineral acids, Lactic acid), . . . 37-59 

Order 3. — Alteratives — (Preparations of Mercury and of 
Gold, Iodine, the Iodides, Arsenical preparations, Cod-liver 
oil, the Phosphates and Hypophosphites, Calcium chlo- 
ride, Ammonium chloride, Colchicum, Sarsaparilla, Guaiac, 
Mezereum, Menispermum, Calendula, Sassafras, Stillingia, 
Dulcamara, Lappa), 59-77 

Order 4. — Antipyretics — (Antipyrine, Acetanilid, Phen- 
acetiu, Phenocoll, Quinine, Saliciu, the Salicylates, Salol, 
Salophen, Guaiacol, Resorcin, Hydroquinoiie, Pyrocatechiu, 
Chinoline, Thalline, Kairine), 77-90 

Class II. — Medicines Acting on the Body, by their 

Effects on the Various Organs, 90-202 

(a) On the Nervous System, 90-146 

Order 1. — Hypnotics — (Opium and its alkaloids, Chloral, 
Chloralamide, Chloralose, the Bromides, Hyoscine, Sulpho- 
nal, Trional, Tetronal, Paraldehyd, Urethan, Cannabis 
Indica, Humulus, Lactucarium), 90-107 

Order 2. — Mydriatic Anodynes — (Belladonna, Strain o- 
- nium, Hyoscyamus, Duboisia, Coca, and their alkaloids, 

Antipyrine), 107-116 

Order 3. — Anaesthetics— (Ether, Chloroform, Nitrous 
oxide, Methylene bichloride, Ethyl bromide, Bromoform). 
Local Anesthetics — (Cold, Rhigolene, Ether, Ethyl chlo- 
ride, Cocaine, Eucaine, Menthol, Guaiacol, Tincture of 
aconite), 116-126 

Order 4. — Antispasmodics — (Musk, Valerian, the Valer- 
ianates, Asafetida, Camphor, Monobromated camphor, Ethe- 
real oil, Hoffmann's anodyne, Cypripedium, Scutellaria), . 126-130 

Order 5. — Excito-motors — (Nux vomica and its alka- 
loids, Rhus toxicodendron, Picrotoxin), 130-134 

Order 6. — Depresso-motors — (Physostigma, Chloral, the 
Bromides, the Nitrites, Gelsemium, Prussic acid, the 
Cyanides, Oil of Bitter Almond, Lobelia, Conium, Woorara, 
Tobacco), 134-146 



TABLE OP CONTENTS. 13 

PAGES 

(b) On the Organs of Circulation, 140-169 

Order 1. — Stimulants — (Alcohol, Ether, Ammonium, 

Amyl nitrate, Nitroglycerin, Atropine, Digitalis, Caffeine, 
Adonidine, Strophanthus, Sparteine, Strychnine, Cimici- 
fuga, Convallaria), . . 146-159 

Order 2. — Sedatives — (Antimonial preparations, Aconite 
and its alkaloids, Veratrum Viride, Veratriue, Gelsemium, 
Pulsatilla, Arnica, the Vegetable acids), 159-169 

(c) On the Sexual Organs, 169-177 

Order 1. — Aphrodisiacs — (The Tonics generally, espe- 
cially Phosphorus, Zinc phosphide, and Iron. The Phos- 
phates and Hypophosphites, Gold, Arsenic, Cod liver oil, 
Opium, Alcohol, Cannabis Indica, Musk, Camphor, Nux 
vomica, Stimulants, Hamamelis, Ergot, Cantharides, 
Myrrh), 169 

Order 2. — Anaphrodisiaes — (Nauseants, Purgatives, 
Opium (full doses), the Bromides, Monobromated cam- 
phor, Iodine and the Iodides, Potassium nitrate, Ammo- 
nium chloride, Belladonna, Tobacco, Conium, Cardiac seda- 
tives, Digitalis, Cocaine), 170 

Order 3.— Oxytocics— (Ergot, Hydrastis, Hydrastinine 
hydrochlorate, Cotton-root bark, Quinine), 170-174 

Order 4.— Uterine Sedatives— (Opium, Cannabis Indica, 
the Bromides, Chloral, Tartar emetic, Ether, Viburnum 
prunifolium), 174-175 

Order 5.— Emmenagogues— (Preparations of Iron, of 
Arsenic, and of Manganese, Myrrh, Aloes, the Salines, Potas- 
sium permanganate, Savine, Tansy, Apiol, Cantharides, 
Guaiac), 175-177 

(d) On the Alimentary Canal, 177-202 

Order 1.— Emetics— (Ipecac, Apomorphine, Mustard, 

Zinc sulphate, Copper sulphate, Alum, Turpeth mineral, 

Tartar emetic), 177-181 

Order 2.— Gastric Seda tives— (Calomel, Ice, Lime-water, 
Brandy, Morphine, Diluted hydrocyanic acid, Creasote, 
Bismuth, Carbolic acid, Thymol, Sulphurous acid, the 
Sulphites, Charcoal, the Bromides, Nux vomica, Cereum 



14 TABLE OF CONTENTS. 

PAGES 

oxalate, Ipecac (minute doses), Fowler's solution, Counter- 
irritation), 181-182 

Order 3. — Carminatives — (Asafetida, Eucalyptus, Ether, 
Capsicum, Pepper, Cinnamon, Nutmeg, Mace, Cloves, All- 
spice, Ginger, Cardamoms, Aromatic powder, Aromatic 
fluid extract, Oil of cajuput, Calamus, Oil of gaultheria, 
Oil of lavender flowers, Peppermint, Spearmint, Oil of 
rosemary, Pennyroyal, Horehound, Sage, Oil of thyme, 
Fennel, Caraway, Anise, Coriander, Star anise, Orange- 
peel, Orauge-flowers, Vanilla, Oil of turpentine), 182-188 

Order 4. — Cathartics— (Tamarinds, Manna, Cassia fis- 
tula, Frangula, Cascara sagrada, Castor oil, Sulphur, Sul- 
phurated potassa, Rhubarb, Juglans, Aloes, Senna, Lep- 
tandra, Euonymus, Mercurials, Magnesia, Magnesium 
carbonate, Epsom salt, Effervescent magnesium citrate and 
its solution, Glauber's salt, Sodium phosphate and pyro- 
phosphate, Potassium sulphate, Potassium bitartrate, Ro- 
chelle salt, Seidlitz powder, Manganese sulphate, Jalap, 
Bryony, Podophyllum, Iris, Tetterwort, Scammony, Colo- 
cynth, Gamboge, Compound catbartic pills, Vegetable 
cathartic pills, Elaterin, Croton oil, Enemata), 188-199 

Order 5. — Anthelmintics — (Spigelia, Chenopodium, San- 
tonica and Santonin, Aspidium, Pomegranate and Pelle- 
tierine, Cusso, Pumpkin-seed, Kamala, Oil of turpentine, 
Calomel, Sulphur, Infusion of quassia, Sodium chloride, 
Naphtol, Tannin, Alum-water, Lime-water, Injections of 
sweet oil), 199-202 

Class III. — Medicines Acting on the Body by their 
Effect on the Various Secretions and Excre- 
tions, 202-244 

Order 1. — Diuretics — (Solution of potassa, Potassium 
carbonate, Potassium bicarbonate, Potassium citrate, Potas- 
sium acetate, Cream of tartar, Potassium nitrate, Potas- 
sium chlorate, Lithium carbonate, Lithium citrate, Lith- 
ium benzoate, Sodium acetate, Strontium lactate, Squill, 
Digitalis, Caffeine, Sodio-theobromine salicylate, Apocy- 
num, Broom, Dandelion, Sweet spirit of nitre, Mercurials, 
Buchu, Pareira, Uva ursi, Chimaphila, Triticum, Juniper, 
Oil of erigeron, Oil of santal, Corn-silk, Turpentine, Co- 
paiba, Cubeb, Matico, Cantharides), 202-217 



TABLE OF CONTENTS. 15 

PAGES 

Order 2. — Diaphoretics — (Ipecac, Dover's powder, Anti- 
inonials, Aconite, Veratruui viride, Salicylic acid, Potas- 
sium citrate, Spirit of niindererus, Sweet spirit of nitre, 
Pilocarpus), 217-221 

Order 3. — Expectorants — (Ipecac, Apomorphiue, Tartar 
emetic, Pilocarpine, Lobelia, Grindelia, Ammonium chlo- 
ride, Senega, Quillaja, Quebracho, Asclepias, Eriodictyon, 
Garlic, Sauguinaria, Ammoniac, Benzoin, Peruvian bal- 
sam, Balsam of tolu, Tar, Terpin hydrate, Terebene, Squill, 
Turpentine, Eucalyptus, Serpentaria, Primus Virginiana), 221-228 

Order 4. — Astringents— (Tannic acid, Gallic acid, Nut- 
galls, Catechu, Kino, Krameria, Logwood, White oak bark, 
Geranium, Witch-hazel, Red and pale rose, Sumach, 
Chestuut leaves, the Lead salts, Alum, Aluminum sul- 
phate, the Salts of copper, of ziuc, of silver, and of bis- 
muth, Cerium oxalate), 22S-241 

Order 5.— Antacids— (Solution of potassa, Spirit and 
aromatic spirit of ammonia, Solution of soda, Sodium 
carbonate, Sodium bicarbonate, Lime-water, Syrup of 
lime, Precipitated calcium carbonate, Prepared chalk and 
its preparations), 241-244 

GROUP II.— Topical Medicines, 244-269 

Class I. — Antiseptics. — (Solution of hydrogen dioxide, Po- 
tassium permanganate, Chlorine-water, Chlorinated 
lime, Labarraque's solution. Mercuric chloride, Bro- 
mine, Iodine, Mercuric oxide. Iodoform, Iodol, Sul- 
phurous acid, the Sulphites and sulphides, Boric 
acid and the borates, Iron sulphate, Lead nitrate, 
Carbolic acid and the carbolates, Creasote, Benzoic 
acid and the benzoates, Naphtalin, Naphtol, Fonnal- 
dehyd, the Antipyretics, Antiseptic oils, Thymol), . 244-256 

Class II.— Irritants 256-262 

Order 1. — Rubefacients — Mustard, Capsicum, Oil of 
turpentine, Ammonia, Burgundy pitch, Canada pitch), . . 256-258 

Order 2. — Vesicants — (Cantharid.es, Potato-bug, Am- 
monia), 258-259 

Order 3. — Pustulants — (Croton oil, Antimonial oint- 
ment), 259-260 



16 TABLE OF CONTENTS. 

PAGES 

Order 4. — Escharotics — (Caustic potash, Caustic soda, 
Arseuious acid, Bromine, Zinc chloride, Acid nitrate of 
mercury, Corrosive sublimate, Potassium bichromate, the 
Mineral acids, Silver nitrates, Copper sulphate, Alum), . . 260-262 

Class III. — Demulcents — (Water, Acacia, Tragacanth, 
Slippery elm-bark, Marshmallow, Flax-seed, Sassafras 
pith, Quince-seed, Liquorice-root, Iceland moss, Irish 

5, Starch, Isinglass), . 263-266 



Class IV. — Emollients — (Lard, Lanolin, Suet, Spermaceti, 
Wax, Oleic acid, Glycerine, Cacao-butter, Cotton-seed 
oil, Oil of benne, Petrolatum, the Demulcents), . . . 266-267 

Class V. — Protectives — (Plasters, Ointments, Plaster of 
Paris, Collodion, India-rubber, Solution of sodium 
silicate), 268-269 

Class VI. — Coloring Agents — (Cochineal, Saffron, Eed 

Saunders), 269 

INDEX, 271 



QUESTIONS AND ANSWERS 



ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS, 



What is meant by the term "materia medica " ? 

Materia niedica is that division of medical science which treats of 
all that relates to the medicines employed in the treatment of dis- 
ease. It embraces the study of the source of remedies, their 
physical and chemical properties, their action in medicinal doses on 
the human body both in health and disease, their poisonous effects 
and the means by which they may be antagonized, and the methods 
of preparing and administering them ; and is closely allied to botany, 
mineralogy, zoology, chemistry, physiology and pathology. 

How may this knowledge be subdivided ? 

Into Materia Medica Proper, Pharmacy, Pharmacology includ- 
ing Toxicology, and Therapeutics. 

What is materia medica proper ? 

By materia medica proper is understood a description of the 
source, and the physical and chemical characteristics of remedies. 

What is pharmacy? 

Pharmacy (yapuanov, a medicine) relates to the preparation and 
combination of remedies. 

What is pharmacology ? 

Pharmacology (<pa.pfj.aKov, a medicine, and Zoyoc, a discourse), 
though originally meaning a "treatise on drugs" or "on phar- 
macy," is now usually applied only to the study of the action of 
drugs on the body, and embraces toxicology (ro^nov, poison with 
2 17 



18 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

which arrows are smeared, and loyo^, a discourse), which deals with 
poisons and their antidotes. 

What are therapeutics ? 

Therapeutics (Qepairevu, I take care of, or, cure) deals with the appli- 
cation of remedies to disease, and may be either empirical or rational. 

How does empirical differ from rational therapeutics ? 

When a remedy is given in any disease because it has succeeded 
in similar cases before, although the manner in which it acts is often 
not understood, it is given empirically. When a remedy is pre- 
scribed because, from a knowledge of its action on the body, it is 
likely that it will antagonize or overcome a particular pathological 
condition, it is administered on the rational plan. Rational thera- 
peutics is the more scientific, and is the outgrowth of pharmacology. 

What are remedies ? 

Remedies are the agents employed in the treatment of disease. 

How may remedies be classified ? 

Remedies are subdivided into mechanical, physical, dietetic, hygi- 
enic and pharmaceutical agents. The first four classes are usually 
treated of in works especially devoted to such. subjects. 

What are mechanical remedies ? 

Venesection ; local bloodletting by means of leeches, cups, scari- 
fications, incisions or punctures ; bandages ; splints ; sutures ; liga- 
tures ; acupressure needle and forceps ; acupuncture ; aspiration ; 
frictions ; massage, etc. , are mechanical remedies and are described 
in works on surgery. 

What are physical remedies ? 

When light, heat or cold, electricity, galvanism or other of the 
physical forces are used in the treatment of disease, they are spoken 
of as physical remedies. They are treated of at length in works on 
physics and in books devoted to them exclusively. 

What is meant by dietetic remedies ? 

All relating to the food of the sick* or to special plans of diet, are 
included under this head. 

* In many diseases the diet is of equal or of more importance than medica- 
tion, e. g., in diabetes mellitus, and in various forms of dyspepsia. 



OFFICINAL PREPARATIONS. 19 

What are hygienic remedies ? 

The clothing, bathing and cleanliness of the sick, the ventilation 
of the sick room, etc. , belong to this subdivision, and will be found 
in works on practice of medicine, but more particularly in those re- 
lating to hygiene. 

What are pharmaceutical remedies ? 

Pharmaceutical remedies or "medicines, are substances not essen- 
tially alimentary, which, when applied to the body, so alter or modify 
its vital functions as to be rendered applicable to the treatment of 
diseases."* It is preeminently with this subdivision that materia 
medica deals. 

What is meant by "official" preparations? 

This term is applied to such remedies as are authorized (officially) 
by the Pharmacopoeia. 

How does a pharmacopoeia differ from a dispensatory ? 

A pharmacopoeia ((papfiaxov, a medicine, and noisa, to make) is a 
book containing directions for the preparation of medicines with the 
object of uniformity of nomenclature, preparation and strength. 
The U. S. Pharmacopoeia has been decennially revised since 1820, 
when it was first authorized by a representative convention of drug- 
gists and physicians, held at Washington. It is an authoritative list 
of remedies, with formulae for such preparations as may be in gen- 
eral use. "A dispensatory diifers from a pharmacopoeia in contain- 
ing the physical and medical history of the various substances." 
It " contains the whole of the pharmacopoeia " "with additions by 
the author, under whose authority alone it usually appears ' ' (Dung- 
lison). It treats, also, of the therapeutics, modes of administration 
and doses of the various drags, ' ' while the pharmacopoeia is restricted 
to the mode of preparing them. ' ' 

How may the official preparations be classified? 

They may be classified, according to their physical state, into solids, 
semi-solids, and liquids. 

Name the official solid preparations. 

Lozenges, papers, pills, powders, and triturations. 

* Biddle's Materia Medica, 11th Ed., 18S9, p. 46. 



20 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are the official semi-solid preparations ? 

Confections, extracts, cerates, liniments, oleates, ointments, plas- 
ters, and suppositories. 

Mention the official liquid preparations. 

Solutions, mixtures, waters, infusions, decoctions, tinctures, spirits, 
wines, glycerites, fluid extracts, honeys, syrups, vinegars, and oleo- 
resins. 

What are lozenges ? 

Lozenges or troches (trochisci) are dry, solid medicines made of 
powders incorporated usually by means of mucilage and sugar, 
intended to be slowly dissolved in the mouth. 

What are papers ? 

Papers (chartce) are made by soaking bibulous paper in medicinal 
solutions (e.g., charta potassii nitratis), or by spreading medicinal 
mixtures on paper (e.g., charta sinapis). 

What are pills? 

Pills (pilulce) are preparations of such size that they can be con- 
veniently swallowed whole. They usually contain some excipient 
to give the proper degree of tenacity to their particles, and are rolled 
into a spherical form. 

What are powders ? 

Powders {pulveres) are dry solid medicines in a minute state of 
subdivision. 

What are triturations ? 

Triturations (triturationes) consist of 1 part of a medicinal sub- 
stance and 9 parts of sugar of milk thoroughly mingled and reduced 
to a fine powder in a mortar. 

What is a confection ? 

Confections or conserves (confectlones) are remedies made into a 
soft mass with sugar, honey, etc. , which render them more pleasant 
to the taste. 

What are extracts ? 

Extracts (extracta) are made by evaporating solutions of vege- 
table substances (or in some cases the juices expressed from plants) 



OFFICINAL PREPARATIONS. 21 

to a pilular consistence. They are called aqueous or watery, alcoholic 
and acetous extracts, according to the menstruum used as a solvent 

What are cerates ? 

Cerates (cerata) are unctuous preparations, intended for external 
application, mixed with wax, spermaceti or resin, which gives them 
a firm consistence, and prevents them from melting at the tempera- 
ture of the body. 

What are liniments ? 

Liniments (Unimenta) are oleaginous preparations, intended for 
external application with friction. 

What are oleates ? 

Oleates (oleata) are solutions in oleic acid of metallic salts or 
alkaloids, and are applied externally. 

What are ointments ? 

Ointments or unguents (unguenta) are medicaments incorpo- 
rated with some fatty substance, and intended for external use. 
They are of the consistence of lard. 

What are plasters ? 

Plasters (emplastra) are preparations spread on linen, muslin, 
silk or sheepskin, and are intended to adhere closely to the surface 
to which they are applied. 

What are suppositories? 

Suppositories (suppositoria) are made by incorporating medicinal 
substances with oil of theobroma, and are intended for introduction 
into the rectum or vagina. They are of conical fcrm, to facilitate 
their insertion. 

What are solutions? 

Solutions (Jiquores) are preparations in which a non-volatile sub- 
stance is entirely dissolved in the menstruum (usually water). 

What are mixtures? 

Mixtures (misturce) are preparations in which, by means of some 
viscid substance, an insoluble medicine is suspended in water. 

What are waters? 

Waters {aquae) are aqueous solutions of gaseous or volatile sub- 
stances. 



22 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are infusions? 

Infusions (infiisa) are aqueous preparations obtained by pouring 
hot or cold water on vegetable substances and allowing it to remain 
sufficiently long to extract the virtues of the drug. 

What are decoctions? 

Decoctions (decocta) are aqueous preparations obtained by boiling 
vegetable substances in water for a few minutes and allowing them 
to cool in closely-covered vessels. 

What are tinctures? 

Tmetures (tincturce) are alcoholic solutions, usually of non-volatile 
substances. Alcohol or diluted alcohol is generally used as a solvent, 
but occasionally the aromatic spirits of ammonia is employed, the 
product being called an ammonia ted tincture. 

What are spirits? 

Spirits (spiritus) are alcoholic solutions of gaseous or volatile sub- 
stances. 

What are wines? 

Wines (vino) are tinctures made with stronger white wine instead 
of alcohol. 

What are glycerites? 

G-lycerites (glycerita) are medicinal substances mixed with glycerin. 

What are fluid extracts? 

Fluid extracts (extracta flm'da) are liquid preparations of uniform 
strength, 1 c.c. of which represent 1 Gm. (about 1 minim to the 
grain) of the crude drug, prepared chiefly with alcohol and glycerin. 

What are honeys? 

Honeys (meUita) are medicines dissolved in honey. 

What are syrups? 

Syrups (syrupi) are composed of medicinal substances, or of flavor- 
ing ingredients in sugar and water. Simple syrup is a concentrated 
solution of sugar in water. 

What are vinegars? 

Yinegars (aceta) are medicinal solutions in diluted acetic acid. 



WEIGHTS AND MEASURES. 23 

What are oleoresins ? 

Oleoresins (oleoresince) are concentrated extracts consisting chiefly 
of the resin dissolved in the oil of the drag from which they are 
obtained. 

May medicines be prescribed in other forms than those 
referred to above ? 

Medicines are often administered in capsules (small, elongated 
gelatine boxes with rounded ends, which dissolve readily in the 
stomach), granules or parvules (very minute pills), emulsions (oils or 
resins suspended in a mixture by means of some viscid material), 
enemata (liquids injected into the rectum for their local or systemic 
effect), or injections (liquids forced by a syringe into the mucous pas- 
sages or cavities, under the skin or into a blood vessel). Inhalations 
of vapors may be employed for their local effect on the broncho- 
pulmonary tract or for their influence on the system at large, and 
gargles may be used as sedative, astringent or disinfecting and 
deodorizing applications to the buccal and pharyngeal mucous mem- 
branes. Externally, poultices (simple or medicated), lotions (washes), 
and fomentations (hot lotions applied on flannel or cloth and allowed 
to remain in contact with the surface), are also often used. 

What weights and measures are used in prescribing and dis- 
pensing medicines ? 

Troy or apothecaries' weight is used in dispensing solids, while 
wine or apothecaries' measure is employed for liquids ; occasionally 
the metrical system is used in prescribing. 

What is apothecaries' weight ? 

In apothecaries' weight the pound is divided into ounces, drachms, 
scruples and grains, as follows : — 

20 grains (gr.) = 1 scruple O). 

60 grains or 3 scruples = 1 drachm ( 3 ). 
480 grains or 24 scruples or 8 drachms = 1 ounce ( ^ ). 
5760 grains or 288 scruples or 96 drachms or 12 ounces = 1 pound (fb). 

The grain (gr.), drachm ( 3 ) and ounce ( J ) should alone he used in 
prescription writing. 



24 ESSENTIALS OF MATERIA MEDlCA AND THERAPEUTICS. 

What is wine measure ? 

In wine measure the gallon is divided into pints, flui-ounces, flui- 
drachms and minims, thus : — 

60 minims (rt\,) = 1 flui-drachm (f g ). 
480 minims or 8 flui-drachnis = 1 flui-ounce (f ^ ). 
7680 minims or 128 flui-drachms or 16 flui-ounces = 1 pint (O). 
61440 minims or 1024 flui-drachms or 128 flui-ounces or 8 pints = 1 
gaUon (C). 
The minim (Tt\J, flui-drachm (fg ), flui-ounce (f ^ ) and, very seldom, 
the pint (O) are used in prescriptions. 

Describe the metrical system of weights. 

In the metrical or decimal system the gramme is multiplied or 
divided by ten, Greek prefixes denoting the multiplication, and Latin 
the subdivisions of the unit ; thus : — 

10 milligrammes = 1 centigramme. 
100 milligrammes, or 10 centigrammes = 1 decigramme. 
1000 milligrammes, or 100 centigrammes, or 10 decigrammes = 1 
gramme. 
10,000 milligrammes, or 1000 centigrammes, or 100 decigrammes, or 
10 grammes = 1 decagramme. 
100,000 milligrammes, or 10,000 centigrammes, or 1000 decigrammes, 

or 100 grammes, or 10 decagrammes = 1 hectogramme. 
1,000,000 milligrammes, or 100,000 centigrammes, or 10,000 deci- 
grammes, or 1000 grammes, or 100 decagrammes, or 10 
hectogrammes = 1 kilogramme. 

In writing prescriptions in the metrical system, the gramme (Gm.) 
alone is used for both solids and fluids, the abbreviation being preceded 
by Arabic figures or decimals denoting the amount of the drug (e. g., 
10.0 Gm.-0.02 Gm., etc.). 

What is a gramme ? 

The gramme is the weight of a cubic centimeter (c. c. ) of distilled 
water at 4° C. (39.5° E). 

What is a centimeter ? 

A centimeter ( T % of an inch) is the t ijo of a metre (39.37 inches), 
which is the ten-millionth part of a quarter of a meridian of the 
earth (or of the distance from the pole to the equator). 



PRESCRIPTION WRITING. 



25 



What relation does the metrical system of weights bear 
to apothecaries' weight and measure ? 

1 gramme = 15.5 grains ; 1 decigramme (0.1 G-m.) = 1.5 grains ; 
1 centigramme (0.01 G-m.) = .15 (or £) grain; 1 milligramme 
(0.001 Gm.) = .015 (or ^) grain ; 1 grain (gr.j) = .06 gramme ; 1 
drachm (3j) = 4.0 grammes (approximately) ; 1 ounce (^j) = 
32.0 grammes (approximately). 

The following table gives the value of grains in the metrical sys- 
tem. (The fractions have not been carried out beyond the fourth 
decimal point.) 



Grains 




Grammes 


Grains Grammes 


T&TT 


= 


0.0006 


3 = 0.194 


5(7 


= 


0.0013 


4 = 0.259 


* 


= 


0.0027 


5 = 0.324 


I 


= 


0.008 


10 = 0.648 


I 


= 


0.016 


30 or 3ss = 1.944 


\ 


= 


0.032 


60 or 3j = 3.888 


3 
"4 


= 


0.049 


120 or 3ij = 7.775 


1 


= 


0.065 


240 or ^ss = 15.551 


2 


— 


0.130 


480orfj =31.103 



As the weight of a c. c. of fluid depends upon its density, 1.0 G-m. 
of a light liquid (e. g., alcohol) will measure more than the same 
weight of a heavy liquid {e. g. , glycerin). Approximately, however, 
Try = 0.06 Gm. ; f 3j =4.0 Gm. (a little less), and f I) = 32.0 Gm. 
(a little less). 

The following table gives the value of minims (of water at 4° C. 
in vacuo) in the metrical system. For ordinary purposes these values 
may be used without correction. 



inin 


is 


Grammes 


1 


= 


0.06161 


2 


= 


0.123 


3 


= 


0.185 


4 


= 


0.246 


5 


= 


0.308 


10 


= 


0.616 


15 


= 


0.924 



Minims Grammes 

20 — 1.232 

30orf3ss= 1.848 

60 or f3j = 3.696 

120 or f^ij = 7.393 

240 or fgss = 14.786 

480orf\5J =29.573 

960 or f^ij = 59.147 



26 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What approximate measurements are used in medicine ? 

Medicines are sometimes ordered in drops instead of minims. As 
the size of the drop depends on a variety of circumstances, this is a 
bad practice. A teaspoonful is often used for f3j, or 5.0 Grin. ; a 
tablespoonful for f^ss, or 20.0 Grm. ; a wineglassful for f^ij ; but 
these are uncertain measures, and should only be employed when an 
excess of the quantity intended would be harmless. Graduated 
medicine glasses are easily obtained, and are much more reliable. 

May a physician prescribe other formulae than those contained 
in the Pharmacopoeia ? 

The physician often extemporizes formulae to meet the require- 
ments of the individual case. 

For what purposes are different remedies often combined in 
a single prescription? 

Remedies are combined to increase or to moderate the effects of 
some single medicine, or to overcome some action which it is unde- 
sirable to produce; to procure the simultaneous action of drugs 
having different effects upon the body, or to form a new chemical 
compound, often differing in its action from those of the substances 
forming it ; for convenience in administering, or for rendering nau- 
seous drugs more palatable. 

What precautions should be used in prescription writing ? 

The physician should be careful, while writing the prescription,^ 

1. To bear constantly in mind the object for which the medicine 
is wanted, in order that he may better combine his remedies to 
accomplish his purpose. 

2. The writing should be clear and distinct, and the words not 
so abbreviated as to be unintelligible or susceptible of more than 
one meaning. Attention to these points will prevent the occurrence 
of mistakes in compounding the medicine. 

3. The doses should neither be large enough nor close enough to- 
gether (in the case of powerful medicines) to cause injurious effects. 
It is better to give too little than too much. 

4. Medicines which form poisonous compounds (as calomel and 
sodium chloride) should not be combined in the same prescription. 

5. Remedies should not be combined (except for particular pur- 



PRESCRIPTION WRITING. 27 

poses) which are physiological antagonists, i. e., which by their 
actions on the body render each other inert, 

6. Remedies should not be combined for internal administration 
which are chemically incompatible, i. e., which will decompose or 
precipitate each other. 

7. The prescription should be as simple as possible, and contain 
as few ingredients as the nature of the case will allow. 

8. It is better not to order a larger quantity of medicine than the 
patient will probably require. 

9. Never send out a prescription without having carefully reread 
it, to be certain no mistake has been made. 

10. Never give a patient a prescription which has been corrected. 
If a mistake has been made, rewrite the prescription entirely. 

Of what parts does a prescription consist ? 

A prescription consists of four parts : — 

1st. The superscription (super, "over," and scribo, "I write"), 
which consists of the sign R (which is possibly an abbreviation for 
Recipe, "take"), and in some cases the name and address of the 
patient, with the date. 

2d. The inscription, the body of the prescription, containing the 
names of the drugs which are to be used, with the amount of each. 

3d. The subscription (sub, "under," and scribo, "I write"), 
the directions to the apothecary regarding the preparation of the 
medicine. 

4th. The signature, commencing with S. or Sig. (Signa, ' ' write ' '), 
and including directions for taking the medicine, the physician's 
name, and frequently the date, which may be placed here instead of 
at the beginning of a prescription. 

It is customary to write the superscription and signature in English 
and the inscription and subscription in much abbreviated medical 
Latin. 

The inscription formerly consisted almost universally of a basis 
(the principal medicine), an adjuvant (to aid its action), a corrective 
(to prevent unpleasant effect), and a vehicle. Although inscriptions 
thus formed are still sometimes seen, particularly in purgative pre- 
scriptions, yet the tendency to simplicity in prescribing is increasing 



28 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

daily, and prescriptions are often found containing only the basis 
and the vehicle. 

Is a knowledge of Latin necessary in writing a prescription? 

A very limited knowledge of Latin is sufficient for ordinary pre- 
scription writing, because, owing to the common practice of abbre- 
viating, the last syllable of the Latin words, which varies with the 
case, is generally omitted. 

Describe the method of writing a prescription. 

Having written the superscription,* the physician places the names 
of the drugs which he wishes to administer, in a vertical column 
under the sign R., writing them in Latin and in the genitive 
case. He next determines how many doses he wishes to prescribe, 
and multiplying the single dose of each drug by the total number of 
doses in the prescription, he sets the amount opposite the corre- 
sponding medicine, expressing the quantity by the proper signs and 
numerals if it is written in apothecaries' weight and measure, or by 
Arabic figures and abbreviations if written in grammes. Thus, 
having determined to prescribe an iron mixture containing 24 doses, 
he might write — 

R. Tincturse Ferri Chloridi, . . f^ij ^ ( 8 Gm. 

Acidi Acetici Diluti, .... fgj I 

Liquoris Ammonii Acetatis, f '^j C 

Elixir Aromatici, f^xiij J 

Next comes the directions to the druggist, which in this case is 
simply to mix the medicines together and which is expressed by the 
Latin word misce, usually abbreviated to M. 

Then follows Sig. or S. (signa), which means the druggist must 
write what follows on the label, as a direction for the patient, "Take 
one teaspoonful in water 3 times a day after eating," ending the 
prescription with the physician's name. 

May the above prescription be written in any other way? 

Instead of writing "Elixir Aromatici f^xiij," he may write 
" Elixir Aromatici quantum, sufficxtfffli}" which means " as much 
of the aromatic elixir as will suffice (to make the whole mixture 
measure) f^iij." 

* The patient's name and address and the date are often omitted. 



ESTIMATION OF DOSE. 29 

Why are the titles of the drugs written in the genitive case ? 

The verb "recipe" (R., "take thou") governs not the drug, but 
the quantity to be taken, which is placed consequently in the accusa- 
tive case ("take thou two drachms") ; the name of the drug limits 
the meaning of the quantity expressed, and according to rule is placed 
in the genitive case and governed by the amount ("take thou two 
drachms" of what? — "of the tincture of the chloride of iron "). 

Given a prescription containing a number of doses of differ- 
ent ingredients, how may a single dose of any one drug 
be ascertained ? 

Calculate the number of doses in the mixture and divide the 
quantity of any ingredient by the number, the result is a single 
dose. 

Thus, the above prescription is a f ^ iij mixture, of which the dose is 
a teaspoonful or f^j. As f^viij = f^j, there are 3 times f^viij or 
f^xxiv in the mixture, consequently 24 doses. To ascertain the 
amount of tincture of chloride of iron in each dose, convert the quan- 
tity of the tincture to minims and divide by 24 : li\,60 = f 3J, there- 
fore ^120 = f 3 ij ; n\,120 -s- 24 = tt\,v, the quantity of the tincture in 
a single dose of the mixture. 

How many doses should a mixture contain ? 

A physician should avoid prescribing more of a medicine than his 
patient will probably want. As a general rule, 24 doses is a suffi- 
cient amount, and forms a prescription in which the single doses of 
the ingredients are easily calculated. 

Thus, if the dose be a teaspoonful (f 3 j ) , 24 doses would make a f % iij 
mixture (see above); if, however, the dose is a dessertspoonful (3IJ), 24 
doses would be twice as much, f^vj. As nUiss X 24 = rr\,60 or f^j, 
the latter amount represents 24 doses of li\iiss each, and consequently, 
if an entire mixture contains 24 doses, f^j of any of its components 
will contain 24 doses of tt\,iiss. 

As solids, when in a thorough state of solution, are equally diffused 
throughout the menstruum, if 3 j or gr. 60 of any solid is dissolved 
in 24 doses of a solution, each dose will contain gr.iiss of the solid. 
Hence, in prescribing — 

1st, write for a f 3 iij mixture if the dose is to be a teaspoonful (f £j), or 
fjvj " " " " dessertspoonful (f 5 ij), 



30 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

in either case the mixture will contain 24 doses. 
2d, recollect that if each dose of such a mixture is to contain gr.iiss or 
rr\nss of any substance, there should be 3 j or f 3 j of the substance in 
the mixture ; 

if each dose should contain gr. v or tt\, v, there should be 3ij or f 3ij ; 
gr. x or TT\, x, " " ^ssorf^ss; 

gr. xx or TT\, xx, " " |j or f gj. 

These rules siinnjify prescription-writing for beginners; 

Can any general rule be formulated for dosage of official 
preparations ? 

As a general rule the fluid extracts may be prescribed in tr\,x doses. 
{Exceptions (the poisons), the fluid extracts of aconite (Tr^ss-ij), bella- 
donna (tt\J— ij ), colchicum root (Tnjj-v), colchicum seed (mjj-x), digi- 
talis (Tnj-ij), nux vomica (TnJ-v), sanguinaria (nij— v), squill (rr\j— ij ) , 
stramonium (tt\j), veratrum viride (tt\J— iv). ) Infusions and decoc- 
tions in f gss-fgij doses. {Exception, infusion of digitalis, f 3j- 
iv. ) Syrups, f 3j-f 3ij doses. {Exceptions, syrup of the iodide of 
iron, TTLv-xxx ; compound syrup of squill, tt^x-xxx. ) Tinctures, 
TT\,v-f3j doses. {Exceptions (the poisons), tinctures of aconite, 
Tnjj-iij ; belladonna, TT\,viij-xxx ; colchicum, tt\,v-xxx ; digitalis, 
tt^v-x ; iodine, TnJ-x ; ipacac and opium, nbv-xv ; nux vomica, Try-. 
x ; opium, Tnjj-x ; deodorized opium, tt\Jj-x ; physostigma, tt\,v-xv ; 
squill, ttlv-xxx; stramonium, tt^v-xv; veratrum viride, Tr\jj-x. ) 
Powders, gr. ij-x. Volatile oils, gtt. j — ij. 

Many preparations can be administered in larger doses than indi^ 
cated by this general rule. 

Mention some circumstances which, by modifying the effects, 
will influence the dose of medicines. 

As the activity of a drug is increased or lessened by the age, sex, 
idiosyncrasy, constitution and habits of the patient, as well as by 
the condition of the digestive and absorbent systems, disease, and 
manner of administration, these circumstances must be considered 
in relation to dosage. 

How does age influence the activity of a drug ? 

Children and old persons are more readily influenced by most 
drugs, particularly narcotics, than adults in the prime of life ; but, 



INFLUENCES THAT MODIFY EFFECTS OF MEDICINES. 31 

as a rule, they bear larger proportionate doses of purgatives. No 
scheme for calculating the doses from the age of the patient alone 
can be relied on in practice. 

What is Dr. Young's rule for calculating the dose for chil- 
dren? 
Convert the child's age into a fraction by using the age itself as a 
numerator and the age + 12 as a denominator, the result being the 
proportion of the adult dose which should be administered to the 

3 3 1 

child. Thus, at three years =— =— of that of the adult. At 

3+12 15 5 

21 years of age the full dose is given. 

What is Dr. Cowling's rule ? 

Dr. Cowling proposed to divide the patient's ?ie.rt birthday hy 24 ; 

thus, at three years the dose would be — =— of that of the adult. 

24 6 

How may the dose for a child be more easily calculated in 
the metric system ? 

Dr. Lauder Brunton proposes to multiply the next birthday by 4 
and divide the result by 100 ; or, what is the same thing, to multiply 
the full dose by the child's next birthday, then by 4, and remove the 
decimal point two places to the left. Thus, if the dose for an adult 

be 1. Gm. , that for a child of 3 years will be 1X4X4 = .160 Gins. 

100 

How do sex, idiosyncrasy, constitution and habits influence 
medicinal effects ? 

Men generally bear larger doses of medicines than women. Many 
persons manifest idiosyncrasies with respect to certain drugs ; thus, 
some are very susceptible to the poisonous effects of even minute 
doses of arsenic ; others cannot take quinine or opium or belladonna 
or the iodides, and in others very dilute solutions of cocaine applied 
to the mucous membranes may cause alarming symptoms. As a 
rule, the larger and more robust the individual, the less easily is he 
influenced by drugs. When a medicine is habitually taken, the 
system becomes tolerant to it, and larger doses are required to pro- 
duce any effect. This is especially the case with opium and 
purgatives. 



32 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

In what way does the condition of the digestive and absorb- 
ent symptoms modify the effects of medicine ? 

During digestion, larger amounts of medicine are borne than can 
be taken fasting. In certain conditions of the alimentary canal, as 
in the third stages of yellow fever and of cholera, during a conges- 
tive chill of the gastro-enteric variety, or during profound opium 
narcosis, absorption from the stomach is slow, if it take place at all. 

What effect does disease have upon the influence of medicines 
on the system ? 
In certain diseases great tolerance is manifested to medicine ; 
thus, in peritonitis and cerebro-spinal fever enormous doses of 
opium are taken with advantage ; in typhoid fever the tolerance to 
alcohol is marked. 

Does the method of administration modify the effect of 
medicines ? 

It does: diuretics act more powerfully when much diluted; saline 
purgatives when concentrated. Usually medicines act more rapidly 
and powerfully when given by the mouth than when administered 
per rectum; still more so when injected under the skin, and most 
powerfully when injected into the blood. 

How may medicines be administered? 

Medicines may be administered by the shin, being either applied 
without friction {enepidermic method), or with friction {epidermic 
method), or else directly to the derma, which has been denuded by 
means of a blister {endermic method). They may also be given 
hypodermicaUy \ by means of a small syringe armed with a long, hol- 
low needle. When thus administered, the dose should be from one-half 
to two-thirds of that which is required by the mouth, and the medi- 
cine should be in a thorough state of solution. Medicines are also 
applied to all the mucous tracts in the form of solutions, vapors (by 
atomization), powders (by insufflation), etc. The gastro-intestinal 
tract is most generally used when a systemic effect is desired, and 
the remedy is given either by the mouth or by the rectum. Sup- 
positories and ointments are occasionally used per vaginam for their 
influence on the system. The broncho-pulmonaiy mucous membrane 
is used for the inhalation of vapors, as ether. Intravenous injection 
is rarely practiced except as a last resort. 



CLASSIFYING MEDICINES. 33 

How are medicines classified ? 

Medicines are usually classified either according to their physio- 
logical action or to their therapeutic uses. The latter is the better 
arrangement. 

The difficulty of grouping medicines is increased by the fact that 
even as yet the study of pharmacology is in its infancy, so that the 
exact physiological group to which many of them belong is not defi- 
nitely determined. The action of most medicines, also, is complex, 
affecting different organs at the same time, and in many instances vary- 
ing much according to the dose and the manner of administration. 

They may be divided accordingly into — 
Group 1. — Systemic Medicines. 

Class 1. — Medicines acting on the body at large by their influence 
on digestion, nutrition (tissue waste and repair), and calorifi- 
cation. 
Order I Digestants. Order II. Tonics. Order III. Altera- 
tives. Order IV. Antipyretics. 
Class 2. — Medicines aeting on the body by their effect on its 
various organs. 

A. On the Nervous System : — 

Order I. Hypnotics. Order II. Mydriatic Anodynes. Order 
III Anaesthetics. Order IV. Antispasmodics. Order V. 
Excito-motors. Order VI Depresso-rnotors. 

B. On the Organs of Circulation: — 
Order I. Stimulants. Order II. Sedatives. 

C. On the Sexual Organs: — 

Order I Aphrodisiacs. Order II. Anaphrodisiacs. Order 
III Oxytocics. Order IV. Uterine Sedatives. Order 
V Emmenagogues. 

D. On the Alimentary Canal: — 

Order I. Emetics. Order II Gastric Sedatives. Order III 
Carminatives. Order IV. Cathartics. Order V. Anthel- 
mintics. 
Class 3. — Medicines Acting on the Various Secretions : — 

Order I. Diuretics. Order II. Diaphoretics. Order III Ex- 
pectorants. Order IV. Astringents. Order V Ant- 
acids. 
3 



34 essentials of materia medica and therapeutics. 

Group 2. — Topical Medicines. 
Class 1. Antiseptics. 
Class 2. Irritants. 

Order I. Rubefacients. Order II. Vesicants. Order III. 
Suppurants. Order IV. Escharc-ties. 
Class 3. Demulcents. 
Class If. Emollients. 
Class 5. Protectives. 
Class 6. Coloring Agents, 



DIGESTANTS. 35 



GROUP I.— SYSTEMIC MEDICINES. 

Class I. — Medicines Acting on the Body at Large 
by Their Influence on Digestion, Nutrition 
(Tissue Waste and Repair) or Calorification. 

OKDER I.— DiGESTANTS. 

What are digestants ? 

Digestants are animal or vegetable substances given to aid diges- 
tion when the normal alimentary secretions are insufficient for this 
function. 
Name the digestants. 

1. Pepsinum {pepsin), a proteolytic ferment obtained from the 
glandular layer of fresh stomachs from healthy pigs. 

2. Ingluvin, a preparation from the gizzard of the domestic 
chicken. 

3. Pancreatinum {p>ancreatin), a mixture of the enzymes naturally 
existing in the pancreas of warm-blooded animals, usually obtained 
from the fresh pancreas of the hog [sus scrofa). 

4. Papain, a ferment obtained from the fruit of Carica papaya 
[Nat. Orel Papayaceae), a tree of South America. 

What are the physiological actions of these substances ? 

1. Pepsin (when combined with an acid) digests albumen, which 
it converts into albuminose. 

2. Ingluvin also aids the digestion of albumen, this action being 
probably due to a bitter principle which it contains and which stimu- 
lates the gastric glands. 

3. Pancreatin (in neutral or alkaline solutions) converts albumen 
into albuminose and starches into glucose and aids in emulsifying fats. 

4. Papain digests albumen and dissolves false membranes, asca- 
rides and taenia. 

What are the therapeutic uses of the digestants ? 

1. Pepsin is useful when the secretion of the peptic glands is not 
sufficient for the purposes of digestion, as in atonic dyspepsia, a/pep- 



36 ESSENTIALS OE MATERIA MEDICA AND THERAPEUTICS. 

sia of infants, anaemia, chlorosis, gastric ulcer and cancel' and 
infantile diarrhoea. It has been used for the relief of reflex vomit- 
ing, as that of pregnancy. It is an invaluable addition to nutritive 
enemata, and has been injected into tumors to arrest their growth 
and aid in their absorption. 

2. Ingluvin is used chiefly for the relief of vomiting of pregnancy, 
also in indigestion accompanied with flatulen-nj , and in acute dys- 
pepsia. 

3. Pancreatin is used in intestinal indigestion, and to aid in emul- 
sifying fats. It is also added to nutritive enemata. 

4. Papain is sometimes used in dyspepsia, to aid the digestion of 
albuminous foods, but more frequently for its solvent action on false 
membranes and taenia. 

Pepsin, pancreatin (under the name of trypsin) and papain have 
been successfully used to dissolve the membranes of croup and diph- 
theria. They are used in solution, either in the form of spray or 
applied by a brash to the part. 

What are the preparations and doses of the digestants ? 

Pepsinum saccharatum (saccharated pepsbi) should digest 300 
times its own weight of freshly coagulated and disintegrated egg- 
albumen, dose gr. v-xxx (0.3-2.0). 

Ingluvin (not official) may be given in doses of gr. v-xv (0.3-1.0). 

Pancreatinum {pancreatin) in doses of gr. v-xv (0.3-1.0). 

Papain (not official) in doses of gr. j-v (0.065-0.49). 

Name some of the substances which are incompatible with 
the digestants. 

Alcohol and many of the mineral salts destroy their properties. 

Alkalies (when sufficiently powerful) interfere with the action of 
pepsin and ingluvin, while materially aiding that of pancreatin. 

Acids retard and finally destroy the action of pancreatin while aid- 
ing those of pepsin and ingluvin. 

How and at what time should the digestants be given ? 

Pepsin and ingluvin should be given with meals, either in solution 
with an acid or in capsules, powder or compressed pill. 

Often they are combined with sodium bicarbonate, to which bis- 
muth is sometimes added, and administered before eating. 



TONICS— SIMPLE BITTERS. 37 

Panereatin is usually given from 2 to 4 hours after meals, com- 
bined with an alkali. 

Papain is taken after meals, in powder, capsule or compressed pill. 



ORDER II.— Tonics. 
What are tonics ? 

Tonics are remedies which, in conditions of debility, impart a 
gradual and permanent increase of vigor to the body or its various 
parts, restoring the energy and strength which were wanting. 



How may tonics be divided 1 
They may be divided into vegt 



igetable and mineral tomes. 

Vegetable Tonics. 
What subdivisions of vegetable tonics are made ? 

Vegetable Tonics are divisible into simple or pure bitters, 
aromatic bitters and peculiar bitters. 

Simple Bitters. 

Mention the simple bitters. 

1. Quassia, the wood of Picraena excelsa (Nat. Orel. Simaru- 
bege, a lofty tree of the West Indies. 

2. Gentiana {gentian), the root of the Gentiana lutea [Wat. Ord. 
Gentianeaa), a plant of the mountainous portions of Central and 
Southern Europe. 

3. Calumba, the root of Jateorrhiza palmata {Nat. Ord. Meni- 
spermacese), a plant of the southeastern coast of Africa. 

4. Chirata, Swertia chirata {Nat. Ord. Gentianeae), a plant of 
India. 

What are their chief chemical constituents 1 

1. Quassia-wood contains quassin, a neutral bitter principle ; 

2. Gentian, an acid, gentisic acid (gentisin) ; a fixed oil, and a 
bitter principle, gentianm or gentiopicrin ; 

3. Calumba, an alkaloid, berberine (which is found in many other 
plants, and has been used as a tonic and febrifuge) ; a bitter princi- 
ple, columbin, and an acid, columbic acid; and 



38 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

4. Chirata, a neutral bitter principle, cliiratin; and an amor- 
phous acid, ophelic. 

What are the physiological actions of the simple bitters ? 

The simple bitters increase the secretions, and impart tone to the 
mucous membranes ; increase the appetite and digestion, and thus 
promote nutrition and improve the condition of the blood, but when 
taken continuously for too long a time they disorder digestion and 
cause gastric catarrh. Gentian, in full doses, by increasing the 
intestinal secretion, acts as a mild laxative. 

Calumba is least likely to disorder the stomach. 

What are the therapeutic uses of the simple bitters ? 

They are given (1) to increase secretion and promote appetite in 
atonic dyspepsia, in chronic gastric catarrh and during convalescence 
from acute diseases. Calumba is the mildest, and, being best adapted 
to weak stomachs, may be used in vomiting of pregnancy and in sea- 
sickness ; quassia, gentian and chirata are well adapted to cases of 
dyspepsia with relaxation or torpor of the mucous membrane and 
resulting constipation. (2) To give tone to the mucous membranes, 
in diarrhoea and in accumulations of flatus in the bowel from a 
relaxed condition, calumba may be used. (3) As vehicles for the 
administration of other medicines, as acids or alkalies. (4) To 
destroy ascarides, an infusion of quassia may be used as an enema. 

What are the preparations and doses of these substances ? 

1. Extractum QuASSliE (extract of quassia), dose gr. j-v (0.065- 
0.5), principally used as an excipient. 

Extractum Quassi^e Fluidum {fluid extract of quassia), dose 
TTtv-xxx (0.308-1.848). 

Tinctura Quassle {tincture of quassia), f 3j-ij (4.0-8.0). 
Quassin (not official), dose gr. }~h (0.016-0.032). 

2. Extractum Gentians (extract of gentian), dose gr. j-xxx 
(0.065-2.0). 

Extractum Gentians Fluidum (fluid, extract of gentian), dose 
f 3ss-j (2.0-4.0). 

Tinctura Gentians Composita (compound tincture of gentian), 
dose f 3ss-ij (2.0-8.0). 

3. Extractum Calumba Fluidum (fluid extract of calumba), 
dose f 3ss-j (2.0-4.0). 



TONICS— AROMATIC BITTERS. 39 

Tinctura CALUMBiE (tincture ofcaJumba), close f3ss-ij (2.0-8.0). 

Berber ine (not official), dose gr. j-x (0.065-0.648) as a sulphate or 
hydrochlorate. 

4. Extractum Chirat^ Fluidum (fluid extract of chirata), 
doseffU-xx (0.616-1.3). 

Tinctura Ciiirat^e (tinctura of chirata), dose fflv-f3j (0.308- 
4.0). 

What medicines should not be prescribed with gentian? 

Iron sulphate and the salts of silver and of lead are incompatible 
with gentian. 

How and at what time should the simple bitters be given ? 

The simple bitters are given before eating, either alone or com- 
bined with other medicines in pills or in mixtures or solutions. 

Aromatic Bitters. 
How do the aromatic differ from the simple bitters ? 

The aromatic hitters are more stimulating to the mucous tract 
than the simple bitters, because of the aromatic volatile oils which 
they contain ; they also contain tannic or gallic acid, which renders 
them more or less astringent. 

Mention the aromatic bitters. 

1. Serpentaria (Virginia snakeroot), the rhizome and rootlets 
of Aristolochia serpentaria (Nat. Ord. Aristolochiacese) and other 
varieties of Aristolochia, indigenous plants ; 

2. Eucalyptus, the leaves of E. globulus or blue gum-tree (Nat. 
Ord, Myrtaceae), a tree of Australia ; 

3. Prunus Virginiana, the bark of P. serotina or wild cherry 
(Nat. Ord, Rosaceae), an indigenous tree ; 

4. Anthemis, the flower-heads of A. nobilis or chamomile (Nat. 
Ord. Compositae), a native of Europe ; 

5. Matricaria, the flower-heads of M. Chamomilla or German 
chamomile {Nat Ord. Compositae) ; 

6. Eupatorium, the leaves and flowering tops of E. perfoliatum, 
boneset or thoroughwort(A r «i. Ord. Compositae), a common indigen- 
ous plant ; 

7. Cascarilla, the bark of Croton Eluteria (Nat. Ord. Euphor- 
biaceae), a small tree of the West India Islands ; and 



40 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

8. Absinthium, the leaves and tops of Artemisia Absinthium or 
wormwood (Nat. Ord. Composite), a European plant. 

What are the chief chemical constituents of the aromatic 
bitters ? 

They all contain a volatile oil, a bitter principle, resin and tannic 
acid. 

The volatile oil of eucalyptus is composed of two terpenes, cymol 
and eucalyptol ; that of Primus Virginiana contains hydrocyanic 
acid, which is formed by the reaction in water of a peculiar ferment 
(not emulsin) existing in the bark, with the bitter principle; that of 
absinthium contains absinthol. 

The bitter principle of serpentaria is called aristolochin ; that of 
anthemis, anthemic acid; that of eupatorium, eupaturin; that of 
cascarilla, cascarillin ; and that of absinthium, absinthin. 

What are the physiological actions of the aromatic bitters ? 

Owing to the bitter principles which they contain, their action on 
digestion, nutrition and secretion is similar to that produced by the 
simple bitters. They have, in addition, a stimulating influence on 
the mucous membranes, due to the volatile oils (which are eliminated 
by the bronchial mucous membrane, skin and kidneys, and increas- 
ing their secretions are, somewhat, expectorants, diaphoretics and 
diuretics), and an astringent effect, owing to their tannic acid. In 
large doses they are emetic and laxative. The oil of eucalyptus 
destroys germs, and is an irritant when applied locally. It quickens 
the pulse and respiration and lowers the blood pressure. In large 
doses it causes diarrhoea, Prunus Virginiana has a sedative influ- 
ence over the pneumogastric nerve, from the hydrocyanic acid which 
is developed in it, and thus quiets cough. Absinthium in large 
doses, or when habitually used in the form of the liqueur (absinthe), 
produces epileptiform convulsions. 

What are the therapeutic uses of the aromatic bitters ? 

They are used for the same purposes as the simple bitters. 

Serpentaria is used as a cardiac stimulant and tonic in low fevers, 
and occasionally as a stimulating expectorant in capillary bronchitis 
and low pneumonias. Eucalyptus is used in chronic catarrhal con- 
ditions of 'the gastric, broncho-pulmonary, and genito-urinary, mucous 



TONICS — AROMATIC BITTERS. 4l 

membranes, and from its destructive influence on germs it is of bene- 
fit in vomiting due to sarcina ventriculi. As an antimalarial agent 
it is far inferior to cinchona, but sometimes proves useful where the 
latter has failed. As a local application, it is employed in stomatitis. 
Prunus Virginiana is also used as a stomachic tonic, but is especially 
employed as a cough-relieving agent in bronchial catarrh and in 
phthisis. 

What are the preparations and doses of these substances? 

1. Extractum Serpentaris Fluidum (fluid extract of serpen- 
taria), dose f&ss-j (2.0-4.0). 

Tinctura Serpentaris (tincture of serpentaria), dose f3j-ij 
(3.0-7.0). 

2. Extractum Eucalypti Fluidum {fluid extract of eucalyptus), 
dose f3ss-j (2.0-4.0). 

Oleum Eucalypti (oil of eucalyptus), dose ^Iv-xv (0.3-1.0) (in 
capsules or in emulsion). 

Eucalyptol, a neutral body obtained from the volatile oil of 
Eucalyptus globulus and of some other species of Eucalyptus, dose 
TTtv-xv (0.3-1.0). 

3. Extractum Pruni Virginians Fluidum [fluid extract of 
prunus virginiana), dose f3j-ij (3.0-7.0). 

Infusum Pruni Virginians (infusion of prunus virginiana), 
dose f^ss-ij (15.0-60.0). 

Syrupus Pruni Virginians (syrup of prunus Virginia) to), dose 
f3j-f|ss (3.5-15.0). 

4 and 5. There are no official preparations of anthemis and matri- 
caria, the latter of which is not much used in this country. They 
are usually given in infusion (chamomile tea) in doses of f^ij (60.0) 
t. i. d., as a stomachic tonic. 

6. Extractum Eupatorii Fluidum (fluid extract of eupato- 
rium), dose f3ss-j (2.0-4.0). 

7 and 8. Cascarilla and absinthium may be given in infusion. 
There are no official preparations. 

At what time should the aromatic bitters be administered ? 

They should be given shortly before meals when intended to pro- 
mote appetite and digestion, but when given for their effects on the 
bronchial or vesical mucous membranes, or for their action on the 
heart, they should be given between meals. 



42 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Peculiar Bitters. 
What are the peculiar bitters ? 

They are such bitters as, owing to peculiarity of action, cannot be 
classed with either of the preceding groups. 

jName the peculiar bitters. 
Cinchona and hydrastis. 

CINCHONA. 

What is cinchona ? 

Cinchona is the barks of all species of Cinchona {Nat. Ord. Kubi- 
acese) which contain not less than 5 per cent, of total alkaloids, and 
at least 2. 5 per cent, of quinine. 

What is the habitat and what are the principal varieties of 
cinchona ? 

The cinchona trees are natives of the mountainous regions of the 
western parts of S. America, from 22° south latitude to 10° north 
latitude, but have been successfully cultivated in India, Ceylon, 
Java, the West Indies and other parts of the world. The two 
principal varieties are cinchona calisaya from which is derived the 
cinchona jiava (yellow or calisaya bark) and the cinchona succi- 
rubra, whence comes the cinchona rubra (red bark). Other vari- 
eties are C. rnicrayiilia and G- condaminea, from which is obtained 
cinchona pallida or pale bark, no longer official. 

How is the bark obtained ? 

The bark was formerly obtained by stripping the trees, but as this 
killed them and threatened to extinguish the genus, the present 
method has been adopted. One-fifth the circumference of the tree 
is denuded of bark in longitudinal strips each year, in the dry season, 
for five years, at the enl of which time the bark has again grown 
ever the portion first denuded. The process is then repeated. 

What are the chemical constituents of cinchona ? 

The most important constituents are the alkaloids quinine and 
cinchonine, of which the former is found to preponderate in the yellow 
bark, the latter in pale barks, and both exist in about equal propor 
tions in red bark. Other important alkaloids are quinidine .and cm- 
chonidme. Combined with these alkaloids are Jrinic, Mnovic, cincho- 
tannic and hinovo-tannic acids. Other less important alkaloids are 



TONICS— CINCHONA. 43 

also found, as aricine, paricine, quinamine and paytine. Quinieine 
and cinchonicine are amorphous modifications of quinine and cin- 
chonine. 

Describe a chemical test for the cinchona alkaloids. 

If quinine and quinidine, or their salts, are treated with fresh 
chlorine-water, an emerald-green precipitate will form when ammo- 
nia-water is added. When the same test is applied to cinchonine, 
cinchonidine, or their salts, a white precipitate results. 

What are the physiological effects of cinchona and its alka- 
loids? 

Locally cinchona and its alkaloids are irritant and antiseptic, de- 
stroying minute organisms or inhibiting their movements. 

Internally it acts on the alimentary canal as a simple bitter, in 
small doses increasing the appetite and digestion ; if long continued, 
producing indigestion and gastric catarrh. In ordinary doses cin- 
chona constipates. In large doses cinchona or its alkaloids irritate 
the mucous membrane and cause vomiting and diarrhoea. 

Nutrition is stimulated and the excretion of waste products in- 
creased by small doses ; large doses, however, diminish the amount 
of urea and uric and phosphoric acids in the urine. In malarial fever 
the products of waste tissue are much increased. 

In the blood it interferes with the oxygen-carrying function of the 
red corpuscles, and diminishes the number, inhibits the movements, 
and prevents the migration of the white corpuscles, both in health 
and disease. 

Circulation : in small doses the cardiac action is increased ; large 
doses, by acting on the cardiac motor ganglia, depress the heart, 
sometimes causing it to intermit, and finally arrest it in diastole ; the 
blood pressure is lowered. 

The temperature in health is very slightly, if at all, influenced ; in 
fevers a rapid decline takes place, due to the action on the blood and 
circulation. 

Nervous system ; small doses stimulate the cerebral functions ; large 
doses cause cinchonism (i. e. , a constricted feeling in the forehead ; 
giddiness and tinnitus aurium, with impairment of hearing and some- 
times of vision) ; after toxic doses these symptoms are aggravated and 
delirium, weak pulse, coma (sometimes convulsions), and in rare 



44 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

cases death, supervene. It probably reduces the reflex excitability 
of the spinal cord, and although it never causes, may energize uter- 
ine contractions when present. Elimination takes place chiefly by 
the urine, the greater portion escaping from the system within eight 
hours. 

Cutaneous eruptions, as erythema, urticaria or herpes are pro- 
duced in some subjects by even small doses of cinchona or its alka- 
loids. 

What are the therapeutic uses of cinchona and its alkaloids ? 

1. As a tonic. The cinchona preparations, as well as the salts of 
its alkaloids, are largely used to improve the appetite and digestion 
in debility, the latter stages of inflammations and in convalescence 
from acute diseases generally, also in atonic dyspepsia (combined 
with a mineral acid), in relaxed conditions of the alimentary mucous 
membrane and in summer complaint of children. The alkaloids are 
also used as tonics to sustain the vital forces in diphtheria, erysipelas, 
pyaemia, septicaemia in all typhoid conditions, in the eruptive fevers, 
and in surgical shock. In the various neuralgias combined with 
other remedies (as morphine or belladonna, iron or arsenic), it is 
% valuable agent. From its influence on the migration of leuco- 
cytes and on cell proliferation it is used (in larger doses) in the early 
stages of inflammation. 

2. As an antipyretic in all conditions of hyperpyrexia quinine may 
)e used in large doses, repeated in about six or eight hours to main- 
tain its effects, but the newer and more powerful antipyretics have 
argely superseded this practice. 

3. As an antiperiodic, cinchona has no rival in the materia medica. 
The salts of the alkaloids are preferred for this purpose. Quinine 
may be used as a prophylactic against malaria in small doses, given 
early in the morning (gr. iij-x, 0.2-0.65). In the treatment of 
intermittent (gr. x (0.65) during the sweating stage, repeated five 
hours before the next paroxysm is expected), remittent (gr. xxx (2.0) 
per day in two doses, given at any time), hemorrhagic and pernicious 
malarial fevers (gr. xx-3j (1.3-4.0) administered promptly by the 
mouth or rectum or even subcutaneously), it acts as a specific. It 
is useful also in malarial cachexia, but must often be combined or 
alternated with arsenic and other treatment. 



TONICS — CINCHONA. 45 

4. Locally, quinine may be applied in solution as an astringent 
and antiseptic to the nares in summer catarrh, etc. , or to the mouth 
in muguet. 

What are the preparations and doses of cinchona and its 
alkaloids ? 

Extractum ClNCHONiE (extract of (yellow bark of) cinchona), 
dose as a tonic gr. x-xxx (0.65-2.0). 

Extractum Cinchona Fluidtjm {fluid extract of (yellow bark 
of) cinchona), dose as a tonic f3j (4-0). 

Tinctura CiNCHONiE (tincture of (yellow bark of) cinchona), dose 
f3j-iv (4.0-15.0). 

Tinctura Cinchona Composita (compound tincture (Huxh&m's) 
of cinchona), containing red bark, serpentaria, bitter orange peel, 
glycerin, alcohol, and water, dose f3j-iv (4.0-15.0). 

Infusum Cinchona (infusion of cinchona), containing aromatic 
sulphuric acid, dose fjjss-ij (15.0-60.0). 

Quinin^e Sulphas (quinine sulphate), the basic sulphate, not 
very soluble in water, but rendered more soluble by the addition of 
diluted sulphuric acid, dose as a tonic, gr. j-vj (0.065-0.4) ; as an 
antipyretic, gr. x-xx (0.65-1.3), repeated as indicated; as an anti- 
periodic, gr. xvj-xx (1.0-1.3) or more. 

Quinine Bisulphas (quinine bisulphate), the normal sulphate, 
more soluble, but containing less quinine than the basic sulphate, 
and given in slightly larger doses. 

Quinine Hydrobromas (quinine hydrobr ornate), better adapted 
for hypodermic injection than the sulphates ; dose, by the mouth, 
the same as of quinine sulphate, a little less when used hypo- 
dermically. 

Quinine Hydrochloras (quinine hydrochlorate), also adapted 
for subcutaneous use ; dose, as of the preceding preparations. 

Quinine Valerianas {quinine valerianate), dose gr.j-vj (0.065- 
0.389). 

QuiNiDiNiE Sulphas (quinidine sulphate), dose slightly larger 
than those of quinine. 

Cinchonin^ Sulphas (cinchonine sulphate), dose £ larger than 
those of quinine. 

Cinchonidin^e Sulphas (cinclwnidine sulphate), dose gr. j-xv 
(0.065-1.0) according to the effects desired. 



46 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What medicines are incompatible with cinchona ? 

The alkalies and alkaline earths precipitate the alkaloids of cin- 
chona ; tannic, gallic and tartaric acid, the tincture and the com- 
pound solution of iodine form insoluble compounds with them ; and 
the ferric salts precipitate cincho-tannic acid from the preparations 
of cinchona. 

How are cinchona and its alkaloids administered ? 

The preparations of cinchona are frequently combined with the 
mineral acids or administered alone as tonics ; the alkaloids are 
given in solution, freshly made pills or capsules, or may be made 
into suppositories, or used subcutaneously. They are often com- 
bined with iron, arsenic and other medicines. Saccharin is said to 
disguise their unpleasant taste. 

HYDRASTIS. 

What is hydrastis? 

Hydrastis is the rhizome and roots of H. canadensis, yellow root 
or golden seal (Nat. Ord. Ranunculacese), an indigenous plant. 

What alkaloids does it contain ? 

It contains hydrastine (not hydrastin, which is an eclectic prepara- 
tion) and berberiue. 

What are its physiological actions ? 

It acts on the appetite, digestion, nutrition and secretions like the 
simple bitters ; it increases the secretions, especially of the glandu- 
lar appendages of the intestine and probably that of the liver ; 
when given to animals in sufficient doses, it is said to act on the ner- 
vous system like stiychnine, but less powerfully, stimulating the 
reflex centres of the spinal cord, heightening the irritability of the 
motor nerves and causing incoordination, tremor, convulsions, and, 
finally, death from tetanic spasm of the respiratory muscles. It is 
also claimed that it always provokes uterine contractions. 

What are the therapeutical applications of hydrastis ? 

It is used as a tonic, to promote appetite, digestion, and nutrition 
in atonic dyspepsia and chronic gastric catarrh. From its effects 
on secretions, it is ueed in catarrhal jaundice, and in constipation 
from deficient secretion, and as a diuretic and blennorrhetic in chronic 
interstitial nephritis and chronic cystitis. It has also been recom- 



MINERAL TONICS. 47 

mended internally to check uterine hemorrhage. As an anti- 
periodic in intermittent fever and chronic malaria it is inferior 
to quinine. 

Locally, it has been used as an application to sore mouth, fissured 
nipples, sores and ulcers generally, and as an injection in gleet and 
vaginal leucorrhoea. 

What are the preparations and doses of hydrastis ? 

Extractum Hydrastis Fluidum {fluid extract of hydrastis), 
dose ir\,v-f3j (0.3-4.0) ; as a stomachic tonic, n\,v-xv (0.3-1.0) before 
meals. 

Tinctura Hydrastis (tincture of hydrastis), dose Nlx-fSj 
(0.6-4.0). 

Glyceritum Hydrastis {glycerite of hydrastis) is chiefly used 
as a local application. 

HYDRASTININ^E HYDROCHLORAS (hydrastinine hydrochlorate) 
has been used to check uterine hemorrhage, and also as a heart tonic 
(vid. oxytocics); dose gr. £-1 (0.016-0.06). 

Mineral Tonics. 

Name the mineral tonics. 

The Mineral Tonics are the preparations of iron and of man- 
ganese (which are sometimes classed separately as hcematinics or 
blood medicines), phosphorus, zinc phosphide, the mineral acids, 
and lactic acid, although of animal origin, is usually considered in 
connection with the latter. 

FERRUM — IRON. 

What is the source of iron ? 

Iron is the most common of all the metals, and is found widely 
distributed both in the metallic state and as oxide, sulphide, carbon- 
ate, phosphate, etc. 

What are the physiological effects of iron ? 

Metallic iron is inert, but when swallowed it is dissolved by the 
acid of the stomach, and forms salts. It probably enters the blood 
as an albuminate. Any iron which is not absorbed passing into the 
intestines, is converted into a sulphide, and colors the stools black. 
Iron exists normally in the red corpuscles of the blood in the pro- 



48 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

portion of 1 part of iron to 230 parts of corpuscles. When deficient 
in the blood, under a coarse of iron the number of corpuscles in- 
crease, the blood is improved in quality, and consequently the tissues 
are better nourished and all the functions of the body are better 
performed. In appropriate cases it promotes the appetite and 
digestion by stimulating the gastric glands, but if given for too long 
a time it disorders digestion. 

The more soluble preparations of iron, if given in large doses, 
cause nausea and vomiting ; its salts, with the mineral acids and 
with iodine, possess more or less toxic properties. 

The sulphates, nitrates and chlorides of iron are astringent, dimin- 
ishing the secretions of the mucous membranes, thus causing con- 
stipation, and coagulating albumen, thus proving haemostatic. Iron 
is eliminated by the faeces, bile and urine. 

What are the therapeutic uses of iron ? 

1. As a general tonic to improve the appetite and digestion, when 
it should be combined with a purgative, as aloes. 

2. To improve the condition of the blood and aid nutrition, in 
anosmia and chlorosis ; in malarial anosmia (with quinine) ; in 
various cachexias, as the scrofulous, strumous or syphilitic (iodides); 
in amenorrhoza, dysmenorrhoea or menorrhagia associated with 
anaemia; in fatty degeneration and in dilatation of the heart; in 
many forms of neuralgia, and in many nervous affections associated 
with anaemia, as epilepsy or chorea; in convalescence from acute 
diseases, and after exhausting hemorrhages. In erysipelas iron is 
almost a specific (tincture of the chloride rr^xx-xxx (1.2-2.0) every 
2 or 3 hours), and in diphtheria it is also useful. 

3. As an astringent it is sometimes used internally in chronic 
diarrhoea and in dysentery. In chronic albuminuria it is useful 
both as a tonic and astringent. 

4. As a hemostatic, in all passive hemorrhages in the anaemic 
(tincture of the chloride), and in hemorrhages from the lungs, 
stomach, bowels or kidneys (subsulphate, tersulphate or nitrate in 
drop doses largely diluted and frequently repeated). 

5. Locally it is employed as a styptic (subsulphate), to check the 
bleeding from hemorrhoids and leech bites, or to arrest capillary 
oozing from a large surface ; in the form of spray in epistaxis, and 



TONICS— IRON. 49 

hcemoptysis, and it is sometimes injected into the cavity of the 
uterus (more or less dangerous) to check bleeding from that organ. 
As an astringent, it is applied to syphilitic vegetations (Monsel's 
solution) and as an injection (largely diluted) in gonorrhoea and 
leucorrhoea. 

What are the preparations of iron and their doses ? 

Ferrum Reductum {reduced iron — Quevennes iron), an impal- 
pable powder of metallic iron, well borne by the stomach, and not 
astringent; dose gr. j-v (0.065-0.324). 

Ferri Oxidum Hydratum (hyd rated ferric oxide) and Ferri 
Oxidum Hydratum cum Magnesia {hydrated ferric oxide with 
magnesia), used almost exclusively as antidotes in arsenical poison- 
ing; dose f^ss (16.0), every 5 or 10 minutes. 

Trochisci Ferri (troches of iron), each lozenge contains of ferric 
hydrate nearly gr. v (0.30). 

Emplastrum Ferri (plaster of iron) contains ferric hj^drate, lead 
plaster, Burgundy pitch, and olive oil. 

FERRI CARBONAS SACCHARATUS {saccharatnl ferrous carbonate), 
dose gr. ij-x (0.130-0.650). 

Massa Ferri Carbonatis (mass of ferrous carbonate— Vallet's 
mass), dose gr. iij-v (0.20-0.30). 

Pilules Ferri Carbonatis (pills of iron carbonate— Elaud 's 
pills). Each pill is intended to contain about gr. j (0.0648) of 
ferrous carbonate, an excellent preparation in anaemia and chlorosis ; 
dose 2-5 pills. 

Mistura Ferri Composite [confound iron mixture— Griffith' s 
anti-hectic mixture), dose, in anaemia or chlorosis, fgss-ij (15.0-60.0). 

Ferri Sulphas (ferrous sulphate — green vitriol or copperas). 
One of the most active and astringent preparations of iron. It is 
irritant to the stomach, and in overdoses a poison. It is used locally 
as a styptic and astringent, and in solution to disinfect privies and 
drains; dose (in pill) gr. ss-ij (0.03-0.13). 

Ferri Sulphas Exsiccatus [dried ferrous sulphate), ferrous 
sulphate deprived of its water of crystallization ; dose gr. \-2 
(0.016-0.13). 

Ferri Sulphas Granulatus (granulated ferrous sulphate), dose 
gr. j-v (0.065-0.30). 
4 



50 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Liquor Ferri Tersulphatis {solution of ferric sulphate), a 
solution of normal ferric sulphate ; rarely used except in making 
hydrated ferric oxide. 

Liquor Ferri Subsulphatis {solution of ferric subsulphate — 
MonseVs solution), a solution of basic ferric sulphate. It maybe 
given internally, largely diluted, as a hasmostatic ; dose n\j-x (0.06- 
0.6). It is chiefly used locally as a styptic. 

Ferri Chloridum (ferric chloride), rarely used internally ; dose 
gr.j-ij (0.065-0.13). 

Liquor Ferri Chloridi {solution of ferric chloride), dose Tr^ij-v 
(0.123-0.30), largely diluted ; externally it is used as a styptic. 

TiNCTURA Ferri Chloridi {tincture of ferric chloride), one of 
the best preparations of iron for internal use. It possesses diuretic 
properties; dose fflv-xxx (0.30-1.85). 

Liquor Ferri et Ammonii Acetatis {solution of iron and 
ammonium acetate — Bashams mixture), an excellent preparation, 
combining tonic and diuretic properties, very valuable in chronic 
desquamative nephritis and chronic dropsies generally ; dose f^ss-j 
(15.0-30.0). 

Ferri Iodidum Saccharatum [saccharated ferrous iodide), dose 
gr. iij-x (0.20-0.65). 

Syrupus Ferri Iodidi (syrup of ferrous iodide), dose ttlv-xxx 
(0.30-1.85). 

Pilul^e Ferri Iodidi (pills of ferrous iodide), dose 1 to 3 pills. 

Ferri Phosphas Solubilis {soluble ferric phosphate), dose gr. 
ij-v (0.13-0.32). 

Ferri Pyrophosphas Solubilis (soluble ferric pyrophosphate), 
dosegr. ij-v (0.13-0.32). 

Ferri Hypophosphis (ferric hypophosjmite), dose gr. v-x 
(0.32-0.65). 

Liquor Ferri Nitratis {solution of ferric nitrate), used inter- 
nally as an astringent and haemostatic; dose Tr\jj-v (0.123-0.30), 
freely diluted. 

Ferri Citras {ferric citrate), dose gr. ij-x (0.13-0.65). 

Liquor Ferri Citratis {solution of ferric citrate), dose ^lij-x 
(0.183-0.61). 

Liquor Ferri Acetatis {solution of ferric acetate), rarely used 
internally; dose tt^x-xxx (0.61-1.85). 



TONICS— IRON. 51 

Ferri Lactas {ferrous lactate), a mild chalybeate, agreeing well 
with the stomach, and useful in anaemia and chlorosis, with weak 
digestion; dose gr. ij-x (0.13-0.65). 

Ferri Valerianas {ferric valerianate), dose gr. j-iij (0.065- 
0.20). 

Ferri et Potassii Tartras {iron and potassium tartrate— -potas- 
sio-tartrate of iron) may be prescribed with alkalies ; dose gr. ij-x 
(0.13-0.65). 

Ferri et Ammonii Tartras (iron and ammonium tartrate), a 
mild preparation; dose gr. ij-x (0.13-0.65). 

Ferri et Ammonii Sulphas {ferric ammonium sulphate- 
am mouio-ferric alum) is given internally as an astringent in chronic 
diarrhoea and dysentery ; dose gr. j-v (0. 065-0. 32). 

Ferri et Ammonii Citras {iron and ammonium citrate), dose 
gr. ij-v (0.13-0.32). 

Vinum Ferri Citratis {wine of iron citrate), dose f3j (4.0). 

Ferri et Quinine Citras (iron and quinine citrate), 

Ferri et Quinine Citras Solubilis {soluble iron and quinine 
citrate), each contains 85 per cent, of feme citrate, and 12 per cent, 
of the alkaloid, and may be given in doses of gr. j-v or x (0.065- 
0.32 or 0.65). 

Yinum Ferri Amarum (bitter wine of iron), dose f3j-ij (4.0-8.0). 

Ferri et Strychnine Citras {iron and strychnine citrate) con- 
tains 98 per cent, of iron and ammonium citrate and 1 per cent, of 
the alkaloid; dose gr. ij-v (0.13-0.32). 

Syrupus Ferri Quinine et Strychnine Phosphatum (syrup 
of iron, quinine, and strychnine phosphates), dose f3j (4.0). 

What medicines are incompatible with the iron prepara- 
tions ? 

I. Tlie alkaline preparations of iron are incompatible with the 
acids and acidulous salts. 

II. The salts formed by mineral acids with iron, with the alkalies 
and alkaline earths and their carbonates. 

III. The iodides, bromides and salts containing vegetable acids, 
with the alkalies and alkaline earths and their carbonates, and with 
acids and (other) acidulous salts. 

IV. ATI theiron preparations, with substances containing tannic or 



52 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

gallic acids, hence they cannot be prescribed with any of the vege- 
table tonics except the simple bitters. 

When and how should iron be administered? 

The fluid preparations should all be given freely diluted. The 
solid preparations may be given combined with other remedies in 
pilular form or in solution. Iron causes less gastric irritation and 
enters the blood more readily if given with or immediately after 
meals. If gastric irritability is present in anaemia, a course of bit- 
ters with the acids had better precede the administration of iron, 
which, as these symptoms subside, may be given in the form of the 
lactate, followed by the bitter wine, and finally by the dried sul- 
phate with arsenic in pill, or by the tincture of the chloride. In 
anaemia iron should be given in rapidly increasing doses until head- 
ache, flushing of the face, and some nausea supervene, when the 
dose should be diminished or the medicine withheld for a few days. 
It is important to overcome the resulting constipation by occasional 
laxatives. 

MANGANUM — MANGANESE. 

What are the sources of manganese ? 

Manganese is obtained from the native (impure) dioxide, and 
also from the carbonate. 

What are its physiological actions ? 

Manganese exists normally in the blood, hair, bile, etc. , associated 
with iron; the proportion to iron in the red corpuscles being as 1 to 
20. Given internally in small doses, it improves the appetite, 
digestion and nutrition ; in larger doses, it depresses the heart's 
action and lowers the blood pressure; if large doses are given for 
some time, the effects resemble those of zinc (wasting and feeble- 
ness, staggering gait, and finally paraplegia). In toxic doses it is a 
gastro-intestinal irritant. The sulphate is an emeto-cathartic and 
cholagogue. Potassium permanganate is a powerful oxidizing 
agent, and hence an antiseptic. It increases the menstrual flow. 

For what medicinal purposes is manganese used ? 

It has been used (1) to improve the condition of the blood in anos- 
mia and chlorosis and in various cachexia, either combined with iron 



TONICS — PHOSPHORUS. 53 

or as a substitute for it ; (2) to improve the appetite and digestion in 
gastrodynia and pyrosis; (3) as a cholagogue in jaundice when of 
malarial origin (sulphate) ; (4) as an antidote to snake bites and other 
animal poisons, and in poisoning by morphine (potassium perman- 
ganate internally and locally) ; (5) in amenorrhea (potassium per- 
manganate) ; and (6) locally as a disinfectant and to correct fetor in 
scarlatina and diphtheria (permanganate as a gargle), or applied to 
cancerous or other ulcers, abscesses, otorrhcea, etc. 

What are the preparations and doses of manganese ? 

Mangani Dioxidum (manganese dioxide), dose gr. j-x (0.065- 
0.65), in pill, powder, or capsule. 

Mangani Sulphas {manganese sulphate), dose gr. j-v (0.065- 
0.32). 

Potassii Permanganas (potassium permanganate), dose gr. ss-ij 
(0.032-0.13) in distilled water, in capsule, or made into pill with 
kaolin. 

What medicines are incompatible with manganese ? 

The salts of lead, silver, and mercury, and the caustic alkalies are 
chemically incompatible with the manganese preparations. 

phosphorus. 

What is the source from which phosphorus is obtained ? 

Phosphorus is obtained from the calcium phosphate of bones. 

What are the physiological effects of phosphorus ? 

Phosphorus exists normally in nervous tissue and in the bones. 
Locally applied, phosphorus causes inflammation, ulceration, and 
even gangrene of the skin. The vapor, when inhaled, irritates the 
mucous membrane, and if caries of the teeth exist, may cause 
caries or necrosis of the maxillae. 

In medicinal doses, phosphorus increases the appetite and diges- 
tion (if too long continued, it disorders digestion), and causes 
eructations of hydrogen phosphide ; increases nutrition, the cardiac 
action and cutaneous circulation, mental activity, sexual activity, the 
formation of the compact tissue of bone, and the excretion of phos- 
phates by the urine. It is eliminated by the liver, kidneys, mucous 
membrane and skin. 



54 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are the toxic effects of phosphorus ? 

From 1 to 3 hours after a poisonous dose has been swallowed, 
violent epigastric pains occur, followed by nausea and vomiting (the 
vomited matter smeUing of phosphorus and being luminous in the 
dark) ; vomiting of blood occurs at a later period ; violent purging 
takes place if the phosphorus passes into the bowel. Jaundice may 
supervene after several days if the patient lives. The pulse is at 
first strong, soon becoming feeble and rapid. There is great thirst, 
restlessness, anxiety, noisy delirium or coma and death, preceded by 
convulsions. The urine is diminished, contains albumen, blood, and 
(after jaundice occurs), biliary pigment. After death, acute fatty 
degeneration of various viscera, as the liver, kidneys, heart and the 
walls of the arterioles and capillaries is found : the red corpuscles 
are altered in form and the blood contains much fat. 

What is the treatment of acute poisoning by phosphorus ? 

1. Give cupric sulphate gr. v (0.32) at once as an emetic and as 
an antidote (forming a less soluble phosphide). 

2. Give hydrated magnesia as a purgative. 

3. Continue the use of cupric sulphate in small doses (gr. T ^ 
(0.005) every fifteen or twenty minutes) as an antidote or emetic, 
or, better, giv r e turpentine (French acid turpentine or old common, 
crude turpentine, which forms with phosphorus an almost insoluble 
spermaceti-like mass) as soon as possible, to neutralize the poison. 

4. Give opium to counteract the general depression. 

5. If the blood is much damaged, transfusion should be resorted 
to. 

6. Never, under any circumstances, give any oils (except turpen- 
tine) or fats, as they increase the solubility of phosphorus. 

What are the medicinal uses of phosphorus ? 

Phosphorus is used as a tonic to promote nutrition : (1) In various 
nervous affections associated with anaemia, as, cerebral exhaustion, 
locomotor ataxia, paralysis agitans, and the various neuralgice; 

(2) in general diseases, as, osteomalacia, rickets and pernicious anaemia ; 

(3) in functional impotence, and (4) as a substitute for arsenic in 
certain skin diseases, as lupus and psoriasis. 



MINERAL ACIDS. 55 

What are the preparations of phosphorus and their doses ? 

Pilule Phosphori [pills of phosphorus) ; each pill contains gr. 
y^o (0.006) of phosphorus; dose j-v pills, t. i. d. 

Spiritus Phosphori [spirit of phosphorus — tincture of phos- 
phorus) contains 1.2 gm. of phosphorus to 1000 c.c. of the prep- 
aration, and is used in making 

Elixir Phosphori [elixir of phosphorus)] each c.c. contains 
0.00025 gm. of phosphorus; dose nu-f3j (0.61-4.0). 

Oleum Phosphoratum [phosphorated oil) contains phosphorus 
(1 percent.) dissolved in ether and almond oil ; dose wlj-v (0.06-0.31). 

Zinci Phosphidum [zinc phosphide) is identical in its actions and 
uses with phosphorus, but not so active ; dose gr. ^-tj, or even \ 
(0.003-0.03) given in pill or granule. 

What medicines are incompatible with phosphorus ? 

Hydratecl magnesia, lime-water, cupric sulphate, powdered char- 
coal and oil of turpentine are chemically incompatible with it. 

What substances aid its absorption? 

The oils and fats. 

What caution should be observed in prescribing it? 

Great care should be taken, especially when large closes are pre- 
scribed, that the remedy be not administered for a long period con- 
tinuously, for fear of causing fatty degenerations of the viscerse. 

Mineral Acids. 

What are the general effects of the acids and alkalies upon 
secretions ? 
Law I. Acids increase alkaline secretions. 
Law II. Acich decrease acid secretions. 
Law III. Alkalies increase acid secretions. 
Law IV. Alkalies decrease alkaline secretions. 

How may these laws be applied to the treatment of digestive 
disturbances ? 

1. To decrease excessive acidity of the gastric juice — 

[a) Give an acid before meals to diminish its secretion, or 
(/>) An alkali after meals to neutralize the acid present. 

2. To increase the acidity of the gastric juice when it is deficient in 
that quality — 



56 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

(a) Give an alkali before meals to increase the secretion of 
acid, or 

(b) An' acid after meals to supply the deficiency. 

Name the mineral acids. 

The mineral acids are sulphuric, nitric, hydrochloric, nitro-hydro- 
chloric and phosphoric. 

What are their physiological effects ? 

Locally the strong acids are escharotics, abstracting water from 
the tissues and combining with the bases. Sulphuric and phosphoric 
acids penetrate the tissues more deeply than the others. Sulphuric 
produces a black, while nitric acid causes a yellow eschar. 

Internally, in a diluted state and in medicinal doses, they increase 
the appetite, digestion and nutrition (hydrochloric and phosphoric 
being more pronounced in their effects). If taken for some time 
continuously, they diminish the acid of the gastric juice and disorder 
digestion (sulphuric acid more quickly than the others). Sulphuric 
acid possesses an astringent influence over the secretions of the skin 
and bowels; nitric acid, on the contrary, appears to increase the 
alimentary secretions and that of the liver. 

They are eliminated by the secretions of the kidneys, bowels and 
skin. In large doses they act as irritant corrosive poisons. 

How should poisoning by the mineral acids be treated ? 

1. Give alkalies or alkaliiie earths (tooth powder or soap may be 
used) to neutralize the acid. 

2. Give eggs, milk, or other demulcents to protect the surface. 

3. Give opium and nutritive and stimulating enemata, or intra- 
venous injection of ammonia, to counteract the resulting depression. 

4. As stricture of the oesophagus often follows in these cases if they 
survive, the passage of an oesophageal bougie should be practiced 
within 3 or 4 months after the poisoning. 

What are the therapeutic uses of the mineral acids ? 

1. For their effects on digestion and nutrition. To prevent excessive 
formation of acid (both where too much is secreted and where it is 
formed by fermentation of the food), diluted hydrochloric or phos- 
phoric acid is given before meals ; or in atonic dyspepsia and indi- 
gestion due to deficient acid, they may be taken after meals (often 



TONICS— SULPHURIC ACID. 57 

combined with pepsin). In fevers, they are used to aid digestion 
and secretions generally and allay thirst (by stimulating the secre- 
tions of the mouth and fauces, thus keeping these parts moist). 

2. For their effects on secretion. Diluted nitric or nitro-hydro 
chloric acid is used internally to increase the secretions, and as a 
bath (f^iij to water Cj), in chronic hepatic congestions and inflam- 
mations, in malarial and catarrhal jaundice and in duodenal catarrh. 
As an astringent in diarrhoeas, dysentery and cholera diluted sul- 
phuric acid is given combined with opium ; and to arrest profuse sweat- 
ing diluted or aromatic sulphuric acid may be temporarily employed. 

3. As a hemostatic the same agent is often used in uterine or in- 
testinal hemorrhage and occasionally in purpura. 

4. In the treatment of, or as a preventive to, lead poisoning diluted 
sulphuric acid is administered (forming an insoluble lead sulphate). 

5. Locally, as an escharotic, fuming nitric acid may be applied 
to chancroids, phagedenic ulcers, hospital gangrene or gangrene in 
wounds. It is also used to remove warts, and as an intra-uterine 
application in various forms of endometritis. As a stimulating 
lotion to unhealthy granulations, and to check bleeding from hemor- 
rhoids, weak solutions of nitric acid are used. 

What are the preparations of the mineral acids, and what 
are their doses ? 

1. AciDUM Sulphuricum {sulphuric acid — oil of vitriol) contains 
not less than 92.5 per cent, of absolute sulphuric acid, and is too 
strong for internal use. 

Acidum Sulphuricum Dilutum {diluted sulphuric acid) contains 
10 per cent., by weight, of the official sulphuric acid, and is used 
internally as a tonic, refrigerant., astringent, and haemostatic; dose 
TTiij-xx (0.123-1.23) freely diluted. 

Acidum Sulphuricum Aromaticum {aromatic sulphuric acid — 
elixir of vitriol) contains 10 per cent, of the official acid, with 
alcohol, tincture of ginger, and oil of cinnamon. It is used as a 
pleasant substitute for the preceding preparation and is given in 
the same doses. 

2. Acidum Nitricum {nitric acid) contains 68 per cent, of the 
absolute acid, and is not employed internally. 

Acidum Nitricum Dilutum {diluted nitric acid) contains 10 per 
cent., by weight, of absolute nitric acid; dose flUj-xx (0.123-1.23) 
freely diluted. 



58 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

3. AciDUM Hydrochloricum [hydrochloric acid—muriatic acid) 
contains nearly 32 per cent. , by weight, of absolute acid, and is not 
used internally. 

Acidum Hydrochloricum Dilutum [diluted hydrochloric add 
— diluted muriatic acid) contains 10 per cent, of the absolute acid. 
It is (probably) a normal constituent of the gastric juice, and is used 
as an aid to digestion ; dose n^v-xx (0.31-1.23) freely diluted. 

4. Acidum Nitrohydrochloricum [nitrohydrochloric acid— 
nitromuriatic acid — aqua regia) is used as a stomachic tonic and 
to increase the secretions of the liver and intestines; dose Nlij-x 
(0.123-1.23) freely diluted. 

Acidum Nitrohydrochloricum Dilutum [diluted nitrohydro- 
chloric acid — diluted nitromuriatic acid) ; dose wiij-xx (0.123-1.23) 
freely diluted. 

5. Acidum Phosphoricum [phosphoric acid) contains 85 per 
cent., by weight, of absolute ortho-phosphoric acid, and is not used 
internally. 

Acidum Phosphoricum Dilutum [diluted phosphoric acid) con- 
tains 10 per cent., by weight, of absolute ortho-phosphoric acid, and 
is chiefly used as an aid to digestion; dose wiv-xxx (0.31-1.85) 
freely diluted. 

What medicines are incompatible with the mineral acids ? 

1. Alkalies and their carbonates and the salts of lime and lead are 
incompatible with the mineral acids, which also decompose salts of 
the vegetable acids, uniting with their bases. 

2. The mercurial salts should not be given during the administra- 
tion of hydrochloric or nitro-hydrochloric acids or their prepara- 
tions, as they may react with the mercury and form corrosive subli- 
mate. 

How and when are these acids administered ? 

They are administered before or after meals, according to the in- 
dications present, and may be given freely diluted with water either 
alone or with glycerin and syrup, or with some of the bitters. 

They should be taken through a glass tube to prevent injury to 
the teeth, or the mouth may be washed out immediately after their 
use with some weak alkaline solution. 



ALTERATIVES. 59 

ACIDTJM LACTICUM — LACTIC ACID. 

What is lactic acid ? 
Lactic acid is a syrupy liquid, formed by the souring of milk. 

What are its effects and uses ? 

It is a normal ingredient of the gastric juice. In medicinal doses 
it increases the appetite, aids digestion and stimulates nutrition. In 
large doses (f3j) or long continued it disorders digestion, causing 
flatulency and epigastric pain. Injected into the peritoneal cavity 
(dog's) it produces endocarditis, and when given for a very long- 
time (in diabetes) it has caused acute rheumatism. Lactic acid is 
used to diminish the acidity of the gastric juice, or to replace the 
deficiency of the acid; to aid digestion and nutrition in oxalic, phos- 
phatic or uric acid diathesis; in diabetes, and locally as a solvent for 
the false membranes of croup and diphtheria. It has been claimed 
that it is a hypnotic in insomnia due to nervous excitement, but this 
is still sub judice. 

What are its preparations and doses ? 

Acidum Lacticum (lactic acid) contains 75 per cent, of absolute 
lactic acid. Dose tt\,v-xxx (0.30-1.85) freely diluted and often pre- 
scribed in a mixture with pepsin. 



ORDER III.— Alteratives. 

What are alteratives ? 

Alteratives are medicines which, without exerting any very 
perceptible action on any particular organ, so modify the nutritive 
processes as to enable nature to restore healthy action in many 
diseased conditions. 

Mention the principal alteratives. 

The preparations of mercury and of gold ; iodine and the iodides .• 
the arsenical preparations ; cod-liver oil ; the phosphates and hypo- 
phosphites ; the chlorides of ammonium and calcium ; colchicum ; 
sarsaparilla ; guaiac ; and perhaps mezereon ; menispermum ; calen- 
dula ; sassafras, stillingia, dulcamara, and lappa. 



60 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
HYDRARGYRUM — MERCURY. 

What is mercury? 

Mercury is a liquid metal principally obtained from the native 
sulphide or cinnabar. 

What are the physiological effects of mercury? 

Metallic mercury (quicksilver) is inert either when swallowed or 
applied to the skin, but if retained in the alimentary canal or after 
prolonged contact with the skin, it often becomes converted into an 
oxide and produces constitutional effects. When inhaled in a state 
of vapor it frequently causes salivation, ulceration of the mouth, 
necrosis and wasting ; or in other cases loss of memory, vertigo, 
shaking palsy and other nervous symptoms. 

Minute doses of mercurials, not too frequently repeated, increase 
the number of red corpuscles in the blood and improve nutrition. 
In small and repeated doses they stimulate the secretions of the 
skin and mucous membranes, the liver and kidneys and the salivary 
glands and pancreas, and promote absorption. Corrosive sublimate 
is an hepatic stimulant of considerable power, but the other prepa- 
rations probably increase the flow of bile by irritating the duodenal 
mucous membrane, thus causing reflex contractions of the gall 
bladder. By stimulating the liver, corrosive sublimate increases the 
formation of urea, and thus proves diuretic. It also feebly stimu- 
lates the intestinal glands. In moderate doses the mercurials are 
cathartic (especially calomel and blue mass). In large doses, or con- 
tinued for some time, the secretions are much increased and become 
pathological ; the gums are swollen and tender, the mouth sore, the 
teeth feel elongated, salivation occurs, which becomes profuse if 
the medicine is continued ; the breath is offensive, a metallic taste is 
experienced ; the proportion of albumen, fibrin and red corpuscles to 
the fluid of the blood is diminished ; the body wastes, and, if the 
abuse of mercury be continued, mercurial fever, diarrhoea, ulceration 
and sloughing of the gums, loosening of the teeth and sometimes 
necrosis of the alveolar processes, albuminuria, marasmus and grave 
nervous symptoms occur. Salivation (ptyalism) is more easily 
caused by blue mass and calomel, less so by corrosive sublimate and 
mercury with chalk. 

Corrosive sublimate, beside its cbolagogue and diuretic properties, 



ALTERATIVES— MERCURY. 61 

retards hyperplasia of connective tissue, is a powerful gastrointes- 
tinal irritant, and locally the best antiseptic, proving rapidly destruc- 
tive to germs. 

What are the symptoms and treatment of poisoning by cor- 
rosive sublimate ? 

The symptoms are violent gastro-enteritis with vomiting and 
purging, bloody stools, abdominal pain and tenderness, albuminous 
urine and death from collapse. The treatment consists in (1 )giving 
an antidote, albumen is the best {white of eggs, milk or wheat 
flour) ; (2) giving an emetic; and (3) the free use of opiates and 
demulcents. 
What are the therapeutic uses of mercury ? 

Mercury is used (1) as an antisyphilitic, either by the mouth 
(yellow iodide, calomel, blue mass, corrosive sublimate), fumigation 
(calomel), inunction (mercurial ointment or oleate), or hypodermic 
injection (albuminate, peptonate, or even calomel or corrosive subli- 
mate). It is of most use in secondary syphilis, the iodides (alone or 
combined with the red iodide or corrosive chloride) giving better 
results in tertiary syphilis. 

(2) As an antiplastic and sorbefacient in acute glandular affections, 
iritis and the latter stages of inflammations after plastic effusion has 
occurred. In diphtheria and membranous croup calomel is advan- 
tageously given in repeated doses guarded by minute doses of opium. 
In the latter disease the subsulphate is often used as an emetic. 
Mercurials are useful in ileo-colitis of infants (gray powder) and in 
acute dysentery (corrosive sublimate). (3) As an indirect tonic and 
to stimulate secretions, calomel, gray powder or blue mass are used 
in dyspepsia attended with constipation and torpid liver, and in the 
early stages of acute diseases. (4) As a purgative calomel and blue 
mass are often used, frequently followed by some saline. (5) Locally 
as antiseptics mercuric chloride or iodide are almost indispensable in 
surgical practice. Various preparations are used locally in various 
skin diseases, especially of parasitic origin, to promote absorption in 
goitre, enlarged spleen, chronic epididymitis and orchitis and other 
glandular swellings. The ointments are also used in conjunctivitis. 

What are the preparations of mercury and their doses ? 
Mass A Hydrargyri (mass of mercury — blue mass), dose as a 



62 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

laxative, gr. v-xv (0.33-1.0) ; as an alterative, antw/philitic, or sorbe- 
facient, gr. ss-iij (0.03-0.2), t. i. d., guarded by opium, and often com- 
bined in the treatment of syphilis with iron or quinine. 

Unguentum Hydrargyri {mercurial ointment — blue ointment). 
Not used internally. Used externally for inunction in syphilis ; as a 
sorbefacient, to destroy pedicidi ; and as a dressing to syphilitic ulcers. 

Emplastrum Hydrargyri [mercurial plaster), used locally as a 
sorbefacient. 

Emplastrum Ammoniaci cum Hydrargyro {plaster of ammo- 
niac with mercury), is more stimulating than the former. 

Hydrargyrum cum Creta [mercury vmh chalk — g ray powder), 
contains mercury, 38 parts, with prepared chalk and sugar of milk, 
and is used as an alterative and antisyplulitic ; dose for an adult gr. 
j-v (0.06-0.32), for a child gr. \ (0.02) t. i. d. ; as a mild laxative gr. 
v-xv (0.33-1.0) (for a child gr. iij-v (0.2-0.33)). It should not be 
prescribed in pill form. 

Hydrargyri Oxidum Bubrum [red mercuric oxide) and 

Hydrargyri Oxidum Flavum [yellow mercuric oxide) are 
rarely used except in the form of 

Unguentum Hydrargyri Oxidi Rubri [ointment of red mer- 
curic oxide — red precipitate ointment) and 

Unguentum Hydrargyri Oxidi Flavi [ointment of yellow mer- 
curic oxide), each containing 10 per cent, of mercuric oxide, and 
which are applied in granular and other forms of conjunctivitis and 
in corneal ulcers. 

Oleatum Hydrargyri [mercurial oleate), contains 10 per cent, 
of the yellow oxide dissolved in oleic acid. Used chiefly for inunction 
in syphilis. 

Hydrargyri Chloridum Mite (mercurous chloride — calomel), 
dose, as a purgative or anthelmintic, gr. ss-j-x (0.03-0.06-0.6) at 
bedtime ; as an ant /'syphilitic gr. ^-j (0.006-0.06), t, i. d. , with opium ; 
as an alterative and absorbent gr. ss-j (0.03-0.06) every 2 or 3 hours; 
for its effect on secretions gr. ss-j (0.03-0.06) t. i. d. ; to arrest vomiting 
gr. tH (0.006-0.06) combined with sodium bicarbonate and fre- 
quently repeated. It is used externally as a dusting powder to the 
conjunctiva, and as an ointment in various skin affections. It is also 
used by fumigation in syphilis. 

Hydrargyri Chloridum Corrosivum [mercuric chloride — cor- 



ALTERATIVES— MERCURY. 63 

rosive sublimate), used as an alterative and aittisyphilitic; dose gr. ^~ 
£ (0.004-0.008) by the mouth, gr. ¥ VtV (0.001-0.004) by hypoder- 
mic injection. Locally, in weak solutions as an injection in gonorrhoea 
after the more acute stage has passed (gr. T V~i— f^viij (0.005-0.008- 
236.5)) or as a tosniacide in ringworm, etc., or for the destruction of 
pediculi. As an antiseptic gr. vijss to hot water Oij = 1 part to 2000. 

Hydrargyri Iodidum Flavum [mercurous iodide), dose as an 
antisyphilitic gr. f-j (0.008-0.065) combined with opium in pill. 
Used also locally, in the form of ointment, to syphilitic ulcers. 

Hydrargyri Iodidum Rubrum [mercuric iodide), dose as an 
alterative ox antisyphilitic gr. ^q-\ (0.004-0.016). It is often com- 
bined with potassium iodide in the treatment of tertiary syphilis, 
and is used locally in the form of ointment to promote the absorp- 
tion of glandular swellings, goitre, enlarged spleen, etc. As an 
antiseptic it is used in solution of gr. iv-vijss (0.259-0.454) to hot 
water Oij (950.3). Potassium iodide increases its solubility. 

Hydrargyri Cyanidum [mercuric cyanide) is used in syphilis as 
a substitute for corrosive sublimate, dose gr. te-ts (0.004-0.005). 

Hydrargyrum Ammoniatum [ammoniated mercury — white pre- 
cipitate) is only used externally as 

Unguentum Hydrargyri Ammoniati [ointment of ammoniated 
mercury), which contains 10 per cent, of ammoniated mercury, and 
is used especially in parasitic skin diseases and to destroy pediculi. 

Hydrargyri Subsulphas Flavus {yellow mercurial sulmlphate 
— turpeth mineral), dose as an alterative gr. ?-ss (0.016-0.032); as 
an emetic in croup, gr. j-v (0.065-0.324), in syrup, repeated every 
10 or 15 minutes until free vomiting occurs. 

Unguentum Hydrargyri Nitratis {ointment of mercurial 
nitrate — citrine ointment), used externally (usually diluted with other 
ointment) in various skin affections, especially those of parasitic 
origin, to destroy pediculi and as a dressing for venereal ulcers. 

Liquor Hydrargyri Nitratis {solution of mercuric nitrate — 
arid nitrate of mercury), used as an escharotic. Diluted with water, 
it forms a useful stimulating application to indolent ulcers. 

What substances are incompatible with the mercurial prepa- 
rations ? 
The metallic preparations and calomel are incompatible with the 



64 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

chlorides, hydrochloric and nitro-hydrochloric acids, which are apt to 
form with them corrosive sublimate. Calomel is also incompatible 
with the alkalies, their carbonates, alkaline earths, soap and the 
hydrosulphates. Corrosive sublimate is decomposed by nearly every- 
thing, and green mercurous iodide is converted into the more active 
red mercuric iodide by combination with iodine and other iodides. 



AURUM — GOLD. 

What are the physiological effects of the salts of gold? 

Locally they are caustic. Internally in small doses they increase 
the appetite, digestion, glandular secretions, and excretions of urine 
and perspiration ; they stimulate the nervous system, and particu- 
larly the spinal cord ; they stimulate the sexual organs, and in 
women (probably) increase the menstrual flow. In larger doses, or 
after prolonged use, they disorder digestion, cause salivation without 
ulceration of the gums, diminish the oxygen-carrying function of the 
red globules, and stimulate the lymphatic system, thus causing 
rapid wasting. In overdoses they are gastro-intestinal irritants, the 
symptoms and antidote being the same as those of poisoning by cor- 
rosive sublimate. 

What are the medicinal uses of the gold salts ? 

They are used as substitutes for corrosive sublimate in the treat- 
ment of tertiary syphilis; as alteratives in scrofula, chronic Bright' s 
disease, myelitis, chronic ovarian inflammations and neuralgia ; and 
as aphrodisiacs in functional impotence. 

The so-called " bichloride of gold" or " Keely cure" does not 
consist in the administration of gold bichloride, as no such salt is 
known. The cures are probably largely effected by suggestion. It 
frequently fails to effect a cure, and many relapses occur. 

What are the preparations and doses of the gold salts ? 

Auri ET Sodh Chloridtjm {gold and sodium chloride) is the only 
official preparation ; dose gr. ^j-fV (0.002-0.006), in pill or capsule. 



ALTERATIVES— IODINE. 65 



IODUM — IODINE. 

What is iodine ? 

Iodine is a non-metallic element, obtained from the ashes of 
seaweed. 

What are the physiological effects of iodine and the iodides? 

Iodine is a disinfectant and antiseptic. Locally applied, it is au 
irritant caustic to the skin and mucous membranes, staining the 
former yellow and causing superficial inflammation and desquama- 
tion, and sometimes even vesication. The vapor, when inhaled, is 
irritant to the air passages. In sufficient amounts it is a gastro- 
intestinal irritant. It enters the blood readily, and, combining with 
sodium or potassium, corresponds, in its constitutional effects, to the 
iodides. They stimulate the lymphatic system and cause the absorp- 
tion especially of newly-formed tissues and diseased cells, thus re- 
moving indolent swellings, inflammatory and syphilitic deposits and 
various metallic poisons, as lead, mercury, etc., which may have 
been deposited in the tissues. When too long administered, they 
cause great emaciation and depression of the vital powers. They are 
rapidly eliminated%y the mucous membranes (irritating them in their 
passage), salivary glands and kidneys. 

Given in large quantities, they cause iodism, i. e. , malaise, some 
fever, frontal headache, coryza, lachrymation, sore throat, difficult 
swallowing, various eruptions on " the face and shoulders and ant- 
aphrodisiac effects, sometimes permanent. The susceptibility varies 
greatly in different persons, but these symptoms may in great measure 
be prevented by copious draughts of water frequently taken during 
the course of treatment. 

What is the treatment of acute poisoning by free iodine ? 

A decoction of starch is the antidote, followed by emetics, and 
opium and demulcents. 

What are the therapeutic uses of iodine and the iodides ? 

They are employed as alteratives and absorbents in the active 
manifestations of tertiary syphilis (iodides chiefly), in the treatment 
of scrofulous and glandular enlargements, in the early stages of 
5 



66 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

cirrhosis of the liver or kidneys, in the various forms of sclerosis of 
the nervous centres, and in chronic poisoning by mercury, lead and 
other metals ; to aid the absorption of lingering pneumonic consoli- 
dation (ammonium iodide) and of plastic and serous inflammatory 
exudations (potassium iodide), in aneurisms (large doses of potassium 
iodide), in chronic rheumatism aud in malaria (iodine preparations). 
For their effects on the mucous secretions the iodides are given in 
chronic bronchitis, spasmodic asthma, catarrhal pneumonia, acute 
catarrh, hay fever and duodenal catarrh. It is highly recommended 
internally in the treatment of typhoid fever, and has been used to 
check the vomiting of pregnancy. Locally, iodine is used by inhala- 
tion in catarrh, coryza and hay fever, and is applied to aid absorp- 
tion and as a counter -iriitant to chronic inflammations and chronic 
glandular and other swellings. The tincture is injected undiluted 
into the serous cavity after the removal of the fluid in empyema, 
hydrocele, etc, , and is applied to the uterine cavity in various forms 
of endometritis. 

What are the preparations and doses of iodine and the 
iodides ? 

Liquor Iodi Compositus {compound solution of iodine — LugoVs 
solution), containing iodine (5 parts), potassium iodide (10 parts), 
and water (85 parts) ; dose tt^v-xv (0.308-0.924) t, i. d. 

TlNCTURA Iodi {tincture of iodine), containing 8 per cent, of 
iodine ; dose ^lij-xv (0. 123-0.924) t. i. d. It is chiefly used externally. 

Unguentum Iodi {iodine ointment) contains iodine (4 parts), 
potassium iodide (I part), water (2 parts), and benzoinated lard (93 
parts). 

Potassii Iodidum (potassium iodide), dose gr. ij-xv-3j (0.130- 
0.972-3.888) t. i. d. 

Unguentum Potassii Iodidi (ointment of potassium iodide) is 
much less powerful than iodine ointment. 

Ammonii Iodidum (ammonium iodide), dose gr. ij-xv (0.132- 
0.972). 

Sodii Iodidum (sodium iodide), dose gr. v-xxx (0.324-1.944). 

Sulphuris Iodidum (sulphur iodide) is but little used ; dose gr. 
H (0.032-0.065). 



ALTERATIVES— ARSENIC. 67 

Strontii Iodidum {strontium iodide) is supposed to be as effica- 
cious as the other iodides and to be less likely to cause iodism; 
dose gr. v-x (0.324-0.648). 

The mercurial iodides and iron iodide have already been men- 
tioned. Arsenic, zinc and lead iodides will be described in their 
appropriate places. 

What are the incompatibilities of these preparations ? 

The iodides are incompatible with the acids and acidulous salts, 
with the soluble metallic salts generally ; with most of the alkaloids 
and with sweet spirits of nitre. Iodine is precipitated from the 
tincture on the addition of water. 

How are iodine and the iodides administered? 

Lugol's solution may be given in syrup and water. The iodides 
may be administered in compressed pill or capsule, or they may be 
given dissolved in water flavored with orange syrup, or in one of the 
bitter tinctures, or in compound syrup of sarsaparilla. Nothing 
effectually disguises their unpleasant taste. 



ARSENUM— ARSENIC. 

What is arsenic ? 

Arsenic is a metallic element, found in various ores combined witt 
other metals as an arsenide. 

Mention some of the tests for arsenic. 

When in powder, if heated with charcoal in a small test tube, it 
sublimes and condenses in the form of a brilliant steel gray ring of 
minute octahedral crystals, soluble in sodium or calcium hypochlo- 
rite. When in solution, the addition of sulphuretted hydrogen 01 
ammonium sulphide produces a lemon-yellow arsenic trisulphide, 
insoluble in diluted hydrochloric acid, but soluble in a solution of 
ammonium carbonate : also the addition of ammonia water followed 
by a solution of silver nitrate, gives a canary -yellow silver arsenite. 
Marsh's and Reinsch's tests should also be used. 



68 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are the physiological effects of arsenical prepara- 
tions ? 

Metallic arsenic is inert, but when swallowed may be converted 
into arsenous acid and cause poisoning. No matter how adminis- 
tered, it has a selective action on the gastro-intestinal and broncho- 
pulmonary mucous membranes. Locally, arsenous acid is a painful 
caustic, and when in sufficient amount produces so much inflamma- 
tion that absorption cannot take place. The inhalation of arsenical 
fumes (as from wall papers) have caused poisoning. Given inter- 
nally in small doses it improves the appetite, digestion, nutrition 
and condition of the blood ; stimulates the secretions of the alimen- 
tary canal and increases peristalsis ; slightly stimulates the respira- 
tory and circulatory centres and the cerebral functions ; and lessens 
the excretion of carbonic acid and urea. In larger doses (not toxic), 
or when taken for some time continuously, it irritates the mucous 
membranes, disorders digestion, gives rise to epigastric pain, nausea 
and vomiting, diarrhoea, tenesmus and sometimes dysentery, palpi- 
tation, oppressed breathing, oedema of the eyelids, albuminuria, 
cutaneous eruptions, tremor and disordered sensation. It is elimi- 
nated by the mucous membrane, liver, kidneys and skin. Tolerance 
is sometimes established, and veiy large doses may be taken without 
poisonous effect. 

What are the symptoms, pathological anatomy and treat- 
ment of acute arsenical poisoning? 

The symptoms of the gastro-intestinal variety of poisoning are 
intense burning pain in the epigastrium, radiating over the abdomen, 
violent vomiting, great thirst, bloody and offensive stools, strangury 
and bloody urine, rapid feeble heart, oppressed breathing and col- 
lapse, sometimes simulating cholera. Those of the cerebral variety 
are sudden, profound insensibility and coma with collapse. 

Pathological Anatomy. — Alimentary mucous membrane congested, 
eroded, softened and ecchymotic ; broncho-pulmonary mucous mem- 
brane and lungs congested ; fatty degeneration of the liver, kidneys 
and other organs. 

Treatment, (1) give a prompt emetic or use the stomach pump; 
(2) give as antidotes hydrated ferric oxide or the hydrated ferric 
oxide with magnesia, and continue the emetics; (3) mucilaginous 



ALTERATIVES— ARSENIC. 69 

drinks to protect the surfaces; (4) large amounts of diluents to 
favor elimination. 

Prognosis. — Death often results long afterward, from the patho- 
logical conditions produced by the poison. 

What are the medicinal uses of the arsenical preparations ? 

Arsenic is used as a tonic and alterative in anaemia and chlorosis, 
persistent malaria, rheumatoid arthritis and chronic rheumatism, 
and to delay the formation of connective tissue in the various scleroses 
and the growth of carcinomata. In minute doses it is used as a 
gastric tonic in irritative dyspepsia, gastric nicer and cancer, and in 
gastralgia and enteral gia. (Fowler's Solution.) In emphysema, 
chronic bronchitis and phthisis it is of value. For its nervous action 
it is used in chorea, neuralgias, paralysis agitans and melancholia. 
In chronic slan diseases, as psoriasis, eczema and acne, it is of the 
greatest service, and in diabetes and sexual debility it is highly 
recommended. Locally, arsenous acid has been used as a caustic 
in lupus, onychia maligna, cancer, and to destroy the nerves of 
carious teeth. Cigarettes made of bibulous paper saturated with 
a solution of sodium arsenate are smoked for the relief of asthma. 

What are the preparations and doses of arsenic ? 

Acldum Arsenosum (arsenous acid— white arsenic), dose gr. T V~ 
^ (0.004-0.005) in pills t. i. d. 

Liquor Potassii Arsenitis (solution of jiotassium arsenite— 
Foicler s Solution) contains arsenous acid gr. ^ in eacli f'3j of solu- 
tion ; dose ny-x (0.061-0.C16) freely diluted. 

Liquor Acidi Arsenosi (solution of arsenous acid), dose n\j- x 
(0.061-0.616) freely diluted. 

Sodii Arsenas {sodium arsenate) is milder in its action than the 
foregoing preparations; dose gr. T V"? (0.005-0.016). 

Liquor Sodii Arsenatis (solution of sodium arsenate), dose 
ttVij-x (0.123-0.616) freely diluted. 

Arseni Iodidum (arsenic iodide), dose gr. I (0.008) t. i. d. 

Liquor Arseni et Hydrargyri Iodidi (solution of arsenic and 
mercuric iodide — Donovans Solution) contains 1 per cent, of arsenic 
iodide and of mercuric iodide each, and is used in obstinate syphilis 
and in papular and squamous skin diseases; dose truj-x (0.123- 
0.616) freely diluted. 



70 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

What medicinal substances are incompatible with these pre- 
parations ? 

The salts of iron, magnesium and calcium and the astringents are 
chemically incompatible with the preparations of arsenic. Fowler's 
Solution should not be prescribed with infusions or decoctions of 
cinchona nor Donovan's Solution with the alkalies, or the salts of 
the alkaloids. 

How and when is arsenic administered ? 

As individual susceptibility to arsenic varies greatly,* it is better 
to give a small dose at first. When it is determined that the patient 
can take arsenic, large doses should be given until some constitu- 
tional symptoms occur, when the medicine is discontinued for a few 
days. Or full doses of the liquid preparations gradually decreased 
to the minimum and as gradually increased may be given when it is 
desirable to continue the medicine for some time. Arsenic is less apt 
to disorder the stomach when freely diluted and taken after eating. 

OLEUM MORRHU^H — COD-LIVER OIL. 

What is cod-liver oil ? 

Cod-liver oil is a fixed oil obtained from the fresh livers of Gadus 
morrhuae, or codfish ( Class Pisces ; Ord. Teleostia; Fam. Gadida). 

What are its principal chemical constituents ? 

It contains various fatty acids, several biliary principles, gaduin, 
iodine, chlorine and traces of bromine. 

What are its physiological effects ? 

Cod-liver oil is more of a food than a medicine. It is readily ab- 
sorbed, whether rubbed into the skin or taken internally. Oil is 
digested in the intestines (not in the stomach), and is readily assimi- 
lated, increasing the deposit of fat in the tissues and the number of 
corpuscles in the blood. In suitable doses it improves the appetite 
and digestion and increases nutrition. In large doses, or in very hot 
weather, it causes nausea and diarrhoea. 



* The author has seen gastro-enterie symptoms follow the administration 
of one dose of Fowler's Solution Taj. 



ALTERATIVES— THE PHOSPHATES AND HYPOPHOSPHITES. 71 

What are its therapeutic applications ? 

Cod-liver oil is used as a nutrient in chronic wasting diseases, par- 
ticularly in phthisis (the earlier it is given, the more pronounced are 
its effects), also in rickets, scrofula, chlorosis, rheumatoid arthritis, 
chronic rheumatism, chronic bronchitis, emphysema and chronic intes 
tinal diseases leading to mal-nutrition. 

It is applied locally for its constitutional effects when it cannot be 
taken internally, and also in squamous skin affections. 

What is the dose of cod-liver oil, and how should it be ad- 
ministered ? 

Oleum Morrhu^ {cod-liver oil) is given in doses of f3j-f:|ss 
(3.696-15.0) t, i. d., and preferably \ to 2 hours after meals. The 
pure oil is the best form for administration. If it nauseates, it may 
be given in emulsion with the hypophosphites, or with mucilage of 
acaciae and oil of lemon. The addition of a few drops of ether 
renders it more easy of digestion. 

THE PHOSPHATES AND HYPOPHOSPHITES. 

What is the chemical difference between a phosphide, a phos- 
phate and a phosphite ? 

A phosphide is formed by the direct union of phosphorus ; a phos- 
phate by the union of phosphoric acid, and & phosphite by the union 
of phosphorous acid with a base. * 

What are the physiological actions of the phosphates and 
hypophosphites ? 

They increase the nutrition of the body. 

Calcium phosphate exists normally in all the tissues of the body, 
and hence is an important nutrient. It is to this salt that bone 
owes its hardness. 

* In other words, whenever a salt ends in ide it is formed hy the union of an 
element with a base (thus, iron ossicle, iron and oxygen ; iron phosphiV/e, iron 
and phosphorus ; iron iodide, iron and iodine ; iron sulph?'c?e, iron and sulphur) ; 
when a salt ends in ate, it shows the union of an acid ending in ic with a base 
(thus, iron phosphate, iron and phosphoric acid ; iron sulphate, iron and sul- 
phuric acid; iron nitrate, iron and nitric acid) ; when a salt ends in ite, it is 
composed of an acid ending in ous and a base (thus, sodium sulph/te, sodium 
and sulphurous acid ; amyl nitn'te, amyl and nitrous acid, etc.). 



72 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are the medicinal uses of these substances ? 

They are used as alteratives and nutrients in diseases of mal-nutri- 
tion, especially when these . salts are wanting in the system, as in 
rickets, mottities ossium, caries and necrosis, delayed union of frac- 
tures, superlactation, prolonged suppuration, anosmia, chronic 
diarrhoea and chronic phthisis. The hypophosphites have been 
lauded in the treatment of phthisis, but probably act only as nu- 
trients. 

What are the preparations of these salts and their doses ? 

Calcii Phosphas Pr^ecipitatus {precipitated calcium phos- 
phate), a very insoluble preparation, and apt to form intestinal con- 
cretions ; dose gr. v-x (0. 324-0. 648). It may be given in milk. 

Syrupus Calcii Lactophosphatis (syrup of calcium lactophos- 
phate) ; the addition of lactic acid renders the calcium phosphate 
much more soluble; dose f3j-iv (4.0-15.0) t. i. d. 

Calcii Hypophosphis (calcium hypophosphite) ; Potassii 
Hypophosphis (potassium hypophosphite) ; Sodii Hypophosphis 
(sodium hypophosphite). may each be given in doses of gr. x-xxx 
(0.048-1.944) t. i. d. Usually administered as 

Syrupus Hypophosphitum (syrup of hypophosphites), dose f3j- 
ij (4.0-8.0) t. i. d. 

Syrupus Hypophosphitum cum Ferro [syrup of hypophos- 
phites with iron) contains 1 per cent, of ferrous lactate ; dose f3j-ij 
(4.0-8.0) t. i. d. 

The ferric phosphates and hypophosphite have been considered 
under iron ; sodium phosphate will be mentioned with the cathartics. 

CALCII CHLORIDUM — CALCIUM CHLORIDE. 

What are the effects, uses, and doses of this salt ? 

Calcium chloride is a gastro-intestinal irritant, and is supposed to 
possess alterative powers in strumous affections, glandular enlarge- 
ments, uterine fibroid and ovarian tumors. Dose gr. x-xx (0.648- 
1.296) in milk or water. 

AMMONII CHLORIDUM — AMMONIUM CHLORIDE. 

What are the effects, uses and doses of ammonium chloride ? 

In addition to the general effects of the ammonium salts (q. v. ) it 



ALTERATIVES— COLCHICUM. 73 

is an alterative and expectorant. Locally it is an irritant. Inter- 
nally, in small doses, it stimulates the mucous membranes, increas- 
ing their secretions and epithelial exfoliation. It stimulates the 
intestinal glands and, perhaps, the liver. It aids the excretion of 
waste products and increases all the solids in the urine except uric 
acid. It is said to increase the menstrual flow in women. In large 
doses it irritates the stomach and intestines and proves purgative. 

It is used as an expectorant (q. v.) and as an alterative in enlarged 
glands, plastic exudations (given internally and used locally), in 
uterine fibroids, functional amenorrhea, in muscular and chronic 
rheumatism and myalgia, and in the early stages of cirrhosis of the 
liver. In albuminoid or waxy infiltration of the liver, kidneys and 
spleen it is a very valuable agent. It is also used in neuralgia and 
neuralgic headache. Externally it is applied as a refrigerant 
(3j (31.10) to water Oss (120.0)) in the early stages of inflammation 
and in the later stages as a sorbefacient. Dose gr. v-xxx (0. 324- 
1.944) every three or four hours, in compressed pills, capsules, or in 
solution with fluid extract of liquorice, which somewhat disguises 
its unpleasant taste. 

COLCHICUM. 

What is colchicum? 

Colchicum is the corm and seed of C. autumnale or meadow saf- 
fron {Nat. Ord. Liliaceae), a native of Europe. 

What alkaloid does it contain ? 

It contains colchicine, which is converted by mineral acids into 
colchicein. 

What are its physiological effects ? 

Locally applied it is irritant. Internally, colchicum, or its alkaloid 
in small doses, increase the secretions generally, particularly the 
urine, increasing greatly the amount of urea and uric acid elimi- 
nated ; in larger doses it causes nausea and vomiting, frequent 
purging, and depresses the heart's action ; in excessive doses it acts 
as an irritant poison, producing violent vomiting and purging, great 
depression, collapse and death by failure of respiration. 

How should poisoning by colchicum be treated ? 

(1) Give emetics and cathartics ; (2) tannic acid, as a partial anti 



74 ESSENTIALS OE MATERIA MEDICA AND THERAPEUTICS. 

dote ; (3) demulcents, to protect the surfaces, and (4) opium and 
stimulants, to counteract the resulting depression. 

What are the therapeutical uses of colchicum? 

Colchicum is used as an alterative and diuretic in acute gout (often 
combined with magnesia and magnesium sulphate (Scudamore's 
draught) or with potassium iodide or other alkali) and in rheuma- 
tism. As a diuretic it is employed in ascites and other varieties of 
dropsy. As a cholagogue it is given in congestions of the portal 
circulation. 

What are the preparations and doses of colchicum ? 

Extractum Colchici Radicis {extract of colchicum root), dose 
gr. j-ij (0.065-0.130) in pill. 

Extractum Colchici Radicis Fluidum {fluid extract of col- 
chicum root), dose niij-iv (0.123-0.246). 

Extractum Colchici Seminis Fluidum {fluid extract of colchi- 
cum seed), dose rruj-vj (0.123-0.40). 

Tinctura Colchici {tincture of colchicum) , made from the seed; 

dose f3ss-j (2.0-4.0). 
Vinum Colchici Radicis {icine of colchicum root), dose nrv-xx 

(0.308-1.232) ; as a purgative f3ss (2.0). 

Vinum Colchici Seminis {wine of colchicum seed), dose ttvv-xxx 
(0.308-2.0)— the best preparation. 

Colchicine (not official), dose for hypodermic use gr. jfe (O.001). 

SARSAPARILLA. 

What is sarsaparilla ? 

SarsapariTla is the root of smilax officinalis and other species of 
smilax {Nat. Ord. Sniilacese), prickly shrubs of Mexico, Central and 
South America. 
What special chemical principle does it contain ? 

A glucoside, called smilacin or panllin, which resembles saponin. 
What are its effects and uses ? 

It has a very slight diaphoretic action, and in large doses is emetic 
and purgative. It is popularly supposed to depurate the blood. It 
has been used as an alterative in tertiary syphilis and in chronic 
rheumatism and various cachectic conditions. 



ALTERATIVES — MEZEREON. 75 

What are its preparations and doses ? 

Extractum Sarsaparill^e Fluidum {fluid extract of sarsa- 
parilla), dose f^ss (2.0) t. i. d. 

Extractum Sarsaparill^e Fluidum Compositum {compound 
fluid extract of sarsaparilla) , containing also sassafras, mezereon, 
and glycyrrhiza ; dose f3j (4.0). 

Decoctum Sarsaparilla Compositum {compound decoction of 
sarsaparilla), containing the above ingredients and guaiac wood; 
dose fgiij-vj (80.0-200.0) t. i. d. 

Syrupus Sarsaparilla Compositus {compound syrup of sar- 
saparilla), containing guaiac wood, pale rose, senna, glycyrrhiza, 
sassafras, anise, and gaultheria. It decomposes corrosive sublimate, 
converting it into calomel. Dose f^ss-j (15.0-30.0) t. i. d. 

GUAIACI LIGNUM — GUAIAC WOOD. 
GUAIACI RESINA— GUAIAC. 

What are these substances ? 

Guaiacum wood, or lignum vitse, is the heart wood of Gr. officinale 
and Gr. sanctum (.Nat Ord. Zygophyllaceae), evergreen trees of S. 
America- 

Guaiac is the resin of the wood of Gr. officinale, and is composed 
of guaiaconic, guaiac and guaiacresinic acids, guaiac beta-resin, 
guaiac yellow and guaiacin. 

What are the effects, uses, preparations and doses of these 
substances ? 

Guaiac ivood and resin slightly increase the secretions of the skin 
and mucous membranes, and in large doses prove emetic and cathar- 
tic. They have been used as alteratives in syphilis and chronic rheu- 
matism, and also as emmenagogues in amenorrhea and congestive 
dysmenorrhea. In tonsillitis the tincture (f^ss (2.0) every 3 or 4 
hours) is of value. 

The preparations are Tinctura Guaiaci (tincture of guaiac) and 
Tinctura Guaiaci Ammoniata {ammoniated tincture of guaiac) ; 
dose of either, f'3ss-ij (2.0-8.0), 3 or 4 times daily, in milk. 

MEZEREUM — MEZEREON. 

What is mezereon ? 
It is the bark of daphne mezereum and other species of daphne 



76 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

(Nat. Ord. Thymelacese), and contains daphnin (a bitter glucoside) 
and an acid resin. Locally it is irritant ; internally in medicinal 
doses it increases the secretions, especially of the salivary glands, 
skin and kidneys ; in overdoses it is an irritant poison and may cause 
death. It is used (generally with sarsaparilla) as an alterative in 
chronic rheumatism, tertiary syphilis and strumous affections, and 
as a masticatory, it has been chewed in paralysis of the muscles of 
the tongue and deglutition. 

Extractum Mezerei Fluidum (fluid extract of mczereon), dose 
nix (0.616). 

What is memispermum ? 

It is the rhizome and roots of M. canadense, yellow parilla or 
Canada moonseed [Nat. Ord, Menispermaceae), and contains berbe- 
rine. It is supposed to be tonic, diuretic, diaphoretic, and alterative, 
and is used as a substitute for sarsaparilla. The only preparation is 
the fluid extract [extractum menispermi fluidum), dose flLv-xxx 
(0.308-2.0). 

What is calendula ? 

Calendula is the fresh floweiing herb of C. officinalis or marigold 
(Nat. Ord, Composite). It contains calendulin, and is supposed to 
be diuretic, diaphoretic and alterative. It is not much used. 

Ttnctttra Calendula {tincture of calendula) ; dose f3ss-j (2.0- 
4.0). It may be used externally (diluted) as an application to 
wounds and contusions. 

What is sassafras ? 

Sassafras is the bark of the root of S. variifolium (Nat. Ord. Lau- 
r'nere), and contains a volatile oil. It is supposed to be a mild alter- 
ative and diaphoretic, and is used in combination with sarsaparilla. 
The oil is used as a flavoring ingredient and as a perfume. 

Oleum Sassafras (oil of sassafras), dose gtt. ij-x (0.06-0.308). 

Whatisstillingia? 

It is the root of S. sylvatica or Queen's Delight {Nat. Ord. Eu- 
phorbiacese) and contains a volatile oil and a resin. It increases all 
the secretions and excretions, slightly stimulates the cardiac action 
and is believed to be alterative. It has been used in secondary and 
in tertiary syphilis, scrofula and chronic rheumatism. 



ANTIPYRETICS. 77 

ExTRACTUM STILLINGI^E FLUIDUM {fluid extract of stillingia), 
dose f3ss (2.0). 

What is dulcamara? 

It is the young branches of solanum dulcamara, woody nightshade 
or bittersweet {Nat. Orel. Solanacese), and contains solamine and 
dulcamarine. It is feebly narcotic, diaphoretic and diuretic. In 
large doses it is a cardiac depressant. It sometimes causes nausea 
and vomiting. It is neither hypnotic nor anodyne. It is chiefly 
used as an alterative in chronic eczema, psoriasis, etc. , and has been 
recommended in whooping-cough, bronchitis and asthma. 

Extractum Dulcamara Fluidum (fluid extract of dulcamara), 
dose f&ss-j (2.0-4.0). 

What is lappa? 

Lappa or Burdoch is the root of Arctium Lappa and other species 
of Arctium (Nat. Ord. Composite). It contains a bitter extractive, 
perhaps a glucoside. tannin, resin, etc., and possesses tonic, laxative, 
and slight diuretic, diaphoretic, and alterant properties. It is used 
in chronic rheumatism, syphilis, and "scrofulous affections" and 
occasionally in chronic cutaneous diseases, as psoriasis and prurigo. 
Locally, it is used as an application to contusions. 

Extractum Lapp^e Fluidum [fluid extract of lapjia), dose 
"ixv-fSj (0.924-4.0). 

ORDER IV.— Antipyretics. 
What are antipyretics, and how do they act ? 

Antipyretic^ are remedies which reduce temperature in fever, but 
in medicinal doses have little or no effect upon it in the normal con- 
dition. The temperature maybe lowered (1) by lessening the pro- 
duction of heat, or (2) by increasing the loss of heat. Heat pro- 
duction maybe diminished either (1) by depressing nutrition (i. e., 
by retarding oxidation and cell-proliferation), or (2) by depressing 
the circidation of the part (as by local abstraction of blood, etc.), 
or of the system (cardiac sedatives) ; while the loss of heat may be 
increased (1) by increased evaporation from the surface (diaphor- 
etics), (2) by increasing heat radiation, through dilatation of the 
cutaneous vessels (amyl nitrite, alcohol, etc.), or (3) by direct with- 
draival of heat from the surface (cold applications, etc. ). The anti- 
pyretic group of medicines act chiefly by their effects on nutrition. 



78 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Mention the principal antipyretics. 

Antipyrine; acetanilid (antifebrin) ; phenacetin; phenacoll; quin- 
ine ; salicin ; salicylic acid and the salicylates ; salol ; salophen ; 
guaiacol ; resorcin ; hydroquinone ; pyrocatechin ; chinoline ; thai- 
line and kairine. 

ANTIPYRINE. 

What is antipyrine ? 

Antipyrine (not official) is an alkaloidal substance usually synthet- 
ically prepared, but also obtained from the destructive distillation 
of coal tar, and belonging chemically to the phenyl group of carbon 
compounds. According to the latest investigations, antipyrine is 
a derivative of pyozol, which is derived from pyrrol. 

What are the physiological effects of antipyrine ? 

Locally applied it is antiseptic, antifermentatwe, and anaesthetic. 
Internally it exerts its influence principally on febrile temperature 
and the nervous system, as an antipyretic and analgesic. In fevers, 
when an antipyretic dose (gr. xx-xxx (1.0-2.0)) is taken, the temper- 
ature rapidly falls several degrees (due principally to its direct action 
upon the heat-regulating apparatus of the nervous system, also 
partly to interference with the oxygen-carrying function of the blood, 
thus diminishing heat-production, and partly to dilatation of the 
cutaneous vessels, thus regulating heat-distribution and increasing 
heat-radiation), and more or less profuse sweating occurs. After 
an interval of from 4 to 12 hours the fever returns, sometimes pre- 
ceded by a chill (which is not as severe as that caused by many of 
the other antipyretics, as kairine) and sometimes (very rarely) by 
depression almost amounting to collapse. Given in the same doses 
to a healthy man it only causes tinnitus aurium, nausea, and a slight 
fall of temperature (about ^°) ; large doses (3j (4.0)) cause vomiting 
and giddiness. 

Antipyrine is quickly absorbed, and probably interferes with nutri- 
tion by combining with the haemoglobin of the red corpuscles, form- 
ing methsemoglobin (the face becomes livid and the lips bluish when 
large doses are taken). It does not permanently impair their func- 
tion nor alter their form. Medium doses stimulate the heart and 
raise the arterial pressure (partly from spasm of the internal vessels) ; 
very large doses (in animals) directly paralyze the heart and lower 



ANTIPYRETICS— ANT1PYRINE. 79 

the blood-pressure. Small doses have little or no effect upon the 
respiration. Given in large doses it increases the rapidity of the 
respiration and in poisonous doses it causes death apparently by 
respiratory paralysis. This action appears to be centric. It is a 
cerebral sedative and analgesic, acting especially on the sensory 
nerves, and dilates the pupils. It is eliminated by the kidne3's, and 
when the perspiration is slight increases the urine. It sometimes 
produces a cutaneous rash and (very rarely in therapeutic doses) 
induces vomiting. It is said to be haemostatic. 

What are the symptoms of poisoning by this drug ? 

When an overdose is taken there are often nausea and vomiting, 
a sense of fulness in the head, tinnitus aurium, relaxation of the 
muscular system and muscular weakness, cyanosis, cutaneous erup- 
tionSj sweating, rapid breathing, and feeble pulse. Occasionally the 
reflexes are absent. Consciousness is retained. 

How should these symptoms be treated ? 

The treatment consists in keeping the patient in a recumbent posi- 
tion ; maintaining the body-heat ; administering alcoholic and diffu- 
sible stimulants ; giving atropine hypodermically and, if the cyanosis 
is marked, inhalations of alcohol. 

The profuse sweating which is sometimes seen is best combated 
by giving atropine or agaricine. 

The cutaneous eruptions rapidly disappear when the drug is 
discontinued. 
What are its therapeutic uses ? 

It is used as an antipyretic in all cases ot hyperpyrexia, as in 
typhoid fever, in sunstroke with high temperature, in the exanthe- 
mata, surgical fever, pneumonia, erysipelas, and influenza. In acute 
rheumatism it not only lowers temperature but relieves the pain. 
It is not an antiperiodic, but may be used to reduce the temperature 
in malarial fevers. 

As an analgesic it is much employed in neuralgia', the "lightning- 
pains ' ' of locomotor ataxia, muscular rheumatism, myalgia, dys- 
menorrhoea, to allay the pains of the first stage of labor, and in 
influenza. In acute coi'yza it is useful as a spray to the nasal 
mucous membrane (4 per cent, solution), preceded by the local appli- 
cation of cocaine. 



80 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What is the dose of antipyrine, and how may it be admin- 
istered ? 

The dose as an antipyretic is gr. xv-xxx (1.0-2.0), repeated as 
circumstances require ; as an analgesic, gr. x-xv (0.648-1.0), repeated 
in from 1 to 4 hours, if necessary. It is given in capsules or in 
solution. As it is non-irritating, it may be used hypodermically. 

It is incompatible with calomel and with sweet spirits of nitre, 
tannates, and solutions of chloral, mercury, arsenic, and carbolic 
acid. 

ACETANILIDUM— ACETANILID. 

What is acetanilid ? 

Acetanilid or antifebrin is a neutral chemical product, obtained 
by the action of glacial acetic acid and heat on aniline. It is an 
acetyl derivative of aniline and is known chemically as phenylaceta- 
mide (C 6 H 5 NH,C 2 H 3 0). 

What are its physiological actions ? 

Like antipyrine, acetanilid is markedly antipyretic and analgesic. 

78 
As an antipjTetic in fevers it acts more slowly than antipyrine, influ- 
encing the temperature in the same manner and being attended 
with the same symptoms and with more marked cyanosis. As the 
temperature declines the pulse becomes slower and stronger and 
the arterial tension is elevated. Gastric and intestinal disturbance 
and other unpleasant concomitants rarely result. Given to healthy 
men in ordinary doses it produces no apparent effect. In decided 
doses acetanilid lessens the conductivity of nerves, depresses the 
reflex centres, and acts as a hypnotic. In poisonous amounts it 
causes motor and sensory paralysis. Its effects are chiefly expended 
upon the sensory cord and nerves. Given to animals in toxic doses, 
beside cyanosis it causes general prostration, stupor, rapidly lowered 
temperature, with primary stimulation and afterward depression of 
the heart and respiration, coma, convulsions, and death. It is elimi- 
nated by the kidneys as para-amido-phenol sulphate. 

What are its uses ? 

It is used as an antipyretic in all cases of high temperature, as 
typhoid fever, acute rheumatism, scarlatina, phthisis, influenza, 



ANTIPYRETICS— PHENOCOLL. 81 

pneumonia, and acute sepsis. As an anodyne it is employed, also, 
in the same diseases in which antipyrine is indicated, and has been 
found useful in epilepsy, particularly in the lesser attacks {petit mat). 
It is also used locally as an antiseptic. 

How may it be administered, and in what doses ? 

The dose of acetanilid is from gr. iv-x (0.25-0.64). It is quite 
insoluble in water, and is better given in capsules or in powder. 

PHENACETIN. 

What is phenacetin ? 

Phenacetin or acetphenetidin (not official) is an acetyl derivative 
of amido-phenol. 

What are its physiological effects ? 

It is a nervous sedative, acting principally upon the sensory por- 
tions of the spinal cord. 

In small doses it has no effect upon the circulatory system. Large 
doses produce a general cyanosis due to the formation in the blood 
of niethsemoglobin. 

It slightly depresses normal temperature, and reduces markedly 
that of fever, usually causing but slight diaphoresis. When admin- 
istered in the evening its effects upon febrile temperature appear to 
be more marked than when given in the morning. After large 
doses, in addition to cyanosis, vomiting, incoordination, hurried 
breathing, and somnolence may occur. 

What are its therapeutic uses and doses ? 

As an antipyretic in febrile conditions generally, as in typhoid 
fever, pneumonia, pleurisy, tuberculosis, influenza, acute rheumatism, 
etc. 

As an analgesic in migraine, headache from any cause, myalgia, 
etc. It is better to administer this, as well as the other coal-tar 
products, cautiously in all cases of weak heart. Dose gr. iij-xx 
(0.2-1.29). 

PHENOCOLL. 

What is phenocoll ? 

Phenocoll (not official) or amidophenacetin is a coal-tnr product 
prepared "by the action of glycocoll, which is amido-acetic acid, 
upon phenacetin. ' ' 
6 



82 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

It is a white crystalline powder and is soluble in 16 parts of water. 
It is incompatible with the alkalies. 

It is said to reduce febrile temperature very rapidly by diminish- 
ing the heat-production without affecting the heat-radiation, and to 
have no unpleasant sequelae, except occasionally profuse perspiration. 

It should be used with care, however, in all cases of prostration, 
as it may then produce cyanosis and cardiac depression. It has 
been used as a hydrochloride for its antipyretic effect in various 
febrile conditions; as an analgesic in acute rheumatism and in 
neuralgia, and as & sedative in whooping-cough. Dose of the hydro- 
chloride gr. v-xv (0.32-1.0). 

QUININE. 

Is quinine used as an antipyretic ? 

Quinine {via 1 , p. 00) was formerly much used for this purpose, but 
at the present time it has been largely superseded by other agents. 

As an antipyretic it is given in doses of gr. x-xx (0.64-1.30) 
repeated as required. 

SALICIN, SALICYLIC ACID, AND THE SALICYLATES. 

What are these substances, and whence are they obtained ? 

Salicin is a neutral principle found in several species of salix. 
Salicylic acid is a derivative of salicin, is found also as a salt (of 
methyl) in oil of gaultheria, and lias been prepared synthetically 
by combining pure carbolic acid with dry carbon dioxide by means 
of heat, The salicylates are the salts formed by the union of this 
acid with bases. 

What are the physiological effects of these substances ? 

The effects of salicin resemble those of salicylic acid, but its 
action is slower and less powerful. It is antipyretic, tonic, antifer- 
mentative, antiseptic, and to a slight extent antiperiodic. It does 
not depress the heart to the same extent as does salicylic acid, and 
is much less toxic. It is eliminated by the urine (chiefly as 
salicylic and salicyluric acids) and by the perspiration, rendering 
both of these excretions alkaline. 

Salicylic acid, when locally applied, is antiseptic and antifermeuta- 
tive. Administered internally in full doses it lowers the temperature 



ANTIPYRETICS— SALICIN, SALICYLIC ACID AND SALICYLATES. 83 

in fevers, causes profuse, sometimes exhausting sweats, and produces 
symptoms similar to those of cinehonism, such as tinnitus aurium, 
partial deafness, headache, etc. After very large doses these symp- 
toms are all increased, and dyspnoea, with depression of the heart and 
nervous system and dilated pupils, is observed. If a toxic dose be given, 
delirium, irregular respiration, involuntary evacuations, stupor, and 
death from respiratory failure occur. In healthy subjects salicylic 
acid in full doses often causes nausea and vomiting, is a cardiac 
depressant, inhibits the movements of the leucocytes, quickens and 
deepens the respiratory movements (producing dyspnoea), is a dia- 
phoretic, does not affect the normal temperature, and is eliminated 
chiefly by the urine, which, if large amounts have been taken, will 
be of a green color (due to an increase of indican). The urine fre- 
quently contains albumin. 

The salicylates administered internally are less irritant to the 
stomach than is salicylic acid; in other respects their effects are 
identical. 

What are the medicinal uses of these substances ? 

Salicin is not much employed. It has been used as an antipyretic, 
especially in rheumatism, for which purpose gr. iij-xv (0.2-1.0) may 
be given every few hours. 

Salicylic acid has been given as an antipyretic in various fevers, 
but is now little used for this purpose except in acute rheumatism in 
robust subjects, where it not only lowers the temperature and moder- 
ates the pain, but materially aids in the elimination of uric acid, yet 
probably does not decrease the frequency of cardiac complications. 
It is also used successfully in ])leurisy with effusion. It has also 
been used with success as an anthelmintic. Externcdly it is applied 
for the removal of corns and warts ; to check sweating of the feet ; 
in eczema ; and as an antiseptic to wounds and ulcers. 

The salicylates are used internally as antipyretics in acute rheuma- 
tism and as autizymotics to prevent fermentation of food in the 
stomach. 

What are the preparations and doses of these remedies ? 

Salicinum {salicin), dose gr. x-3j (0.648-4.0). In acute rheu- 
matism, gr. iij-xv (0.2-1.0) may be given every few hours. 

AciDUM Salicylicum {salicylic acid), dose gr. x-5j (0.648-4.0). 



84 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

In acute rheumatism, gr. x (0.648) may be administered every hour 
until six doses are taken. If more is necessary, decrease the fre- 
quency of the dose. 

Sodii Salicylas (sodium salicylate) (3j (0.648) contains of sali- 
cylic acid gr. 48 (3.12) ; dose gr. v-3j (0.324-4.0). It is more solu- 
ble and less apt to cause vomiting than the acid, and hence is pre- 
ferred for internal use. 

Lithii Salicylas (lithium salicylate) is used for the same pur- 
poses and in the same doses. 

Methyl Salicylas (methyl salicylate — artificial (or synthetic) oil 
of icintergreeii) is a product obtained by the distillation of salicylic 
acid, or its salts, and methyl alcohol in the presence of sulphuric 
acid. It is identical with volatile oil of betula and differs in no re- 
spect from the other salicylates either in physiological action or in 
therapeutic use. It is less irritating to the stomach than the oil of 
gaultheria. Dose nrj- v (0.06-0.31). 

Phenyl salicylate will be described under the head of " saloV 

Physostigmine salicylate will be spoken of in connection with 
physostigma. 

What other official preparations are used for the salicylate 
which they contain ? 

Oleum Gaultheria (oil of gaultheria), a volatile oil distilled 
from Graultheria procumbens or wintergreen. It contains methyl 
salicylate, and acts similarly to salicylic acid upon the system. In 
large doses it is toxic. It is administered for the same purposes as 
are the salicylates in doses of tt\,x-xv (0.61-0.92) in capsules, repeated 
as required. 

Oleum Betula Volatile (volatile oil of betula — oil of sweet 
birch), a volatile oil obtained by distillation from the bark of Betula 
lenta (Nat. Orel. Betulacese). It is identical with methyl salicylate 
and nearly identical with oil of gaultheria. Dose n\j-v (0.06-0.31). 

What should be done if, during the use of these medicines, 
tinnitus aurium or other symptoms of intoxication 
should occur? 
The dose should immediately be decreased or the medicine dis- 
continued. 



ANTIPYRETICS — SALOPHEN. 85 

SALOL. 

What is salol ? 

Salol {phenyl salicylate) is the salicylic ether of phenol and occurs 
as a white crystalline, slightly aromatic, and nearly tasteless powder, 
insoluble in water, but soluble in alcohol. 

What are its physiological effects ? 

Locally it is antiseptic. Internally it lowers febrile temperature 
and produces sweating. The circulation is practically uninfluenced ; 
the respirations increase in frequency and become shallow, tinnitus 
aurium and other salicylic acid symptoms sometimes occur. It is 
somewhat analgesic. In the intestine the pancreatic juice converts 
it into salicylic and carbolic acids, which render antiseptic the re- 
mainder of the alimentary canal. It seems to make the bile more 
watery. It is eliminated chiefly in the urine, which after its use re- 
sists decomposition and becomes darker in color. 

What are its uses and doses ? 

As an antipyretic it is used in acute rheumatism, in typhoid and 
other fevers ; in phthisis and in pneumonia; as an intestinal anti- 
septic in duodenal catarrh, catarrhal jaundice, typhoid fever, and 
cholera ; to prevent decomposition of urine in cystitis and pyelitis, 
and as an analgesic in neuritis, neuralgia, nervous headache, etc. 
It is also employed in pharyngitis and in chronic sore throat depend- 
ing upon the uric acid diathesis. It may be given in any stage of 
gonorrhoea for its influence on the urine. It is also said to be use- 
ful in diabetes. 

Locally it is used as an antiseptic in surgical dressings. Dose gr. 
v-3j (0.324-4.0) in pills, capsules, or in solution in alcohol or oil. 
It should be administered cautiously in disease of the kidneys, be- 
cause of the carbolic acid which it contains. 



SALOPHEN. 

What is salophen ? 

Salophen (not official) is acetylpara-amidophenol salicj'late. Like 
salol it is decomposed in the intestine by the pancreatic juice, being 
split into salicylic acid and actylpara-amidophenol, which is harmless, 
thus possessing an advantage in point of safety over salol. It is 



86 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

chiefly eliminated under these forms in the urine, a small quantity- 
passing unchanged in the stools. It is an antipyretic, intestinal 
antiseptic, and analgesic. Its most marked antipyretic effect is seen 
in acute rheumatism. It has also been used as an intestinal anti- 
septic in typhoid fever, cholera, and dysentery, and as an analgesic in 
sciatica, migraine, and neuralgia. It appears to be non-toxic. 
Dose gr. x-xv (0.64-1.0) in compressed pill or capsule every 2 
hours until gr. xc (6.0) are taken in 24 hours. 

GUAIACOL — GUAIACOL CARBONATE. 

What are guaiacol and guaiacol carbonate ? 

Guaiacol (not official) or methylpyrocatechin is a colorless volatile 
liquid, with a strong aromatic odor, prepared by the fractional dis- 
tillation of beechwood creasote, of which it forms 60 to 90 per cent. 

It is also prepared by the dry distillation of guaiae resin, and, 
synthetically by the action of methyl-sulphuric acid upon pyro- 
catechin. The latter product is the purest form of guaiacol. 

It is slightly soluble in water (1 part in 85, Helbing), but more so 
in ether and alcohol. 

Guaiacol carbonate (not official) is made "by decomposing guaia- 
col in a solution of soda Avith carbonyl chloride. It is a neutral, 
white, crystalline powder, containing 91 per cent, of chemically pure 
guaiacol in combination with 9 per cent, of carbonic acid. ' ' Insoluble 
in water and in cold alcohol, it dissolves readily in ether, in chloro- 
form, and in boiling alcohol, sparingly in the fixed oils and in glycerin. 

What are their effects ? 

When guaiacol is given internally or administered hypodermically 
to healthy persons it produces no effects beyond slight depression 
and slight diaphoresis. When given in suitable doses to febrile 
patients a gradual reduction of the febrile temperature takes place, 
the fever declining for from 2 to 4 hours. When the lowest point 
has been reached the temperature rises rather rapidly to its former 
height, half the time being occupied in the ascent which was re- 
quired for the decline of the temperature. As the temperature falls 
the patient often complains of much depression, but in ordinary 
doses the effects upon the respiration and pulse are evanescent. 

It is eliminated by the lungs and kidneys as guaiaco-sulphuric 



ANTIPYRETICS — GUAIACOL CARBONATE. 87 

ether, giving a dark color to the urine when a large dose has been 
taken. 

There is but one case of poisoning on record. When applied 
locally it is antipyretic and analgesic. It rapidly lowers febrile tem- 
perature, the subsequent rise being, as when it is administered 
internally, much more rapid than the fall. There are also profuse 
sweating and feeble cardiac action approaching syncope. 

The action is most pronounced when applied to the abdomen, not so 
marked when rubbed on the chest, and least marked when applied 
to the thigh (Da Costa), probably because of the relative absorptive 
powers of different parts of the body. 

It appears to lower the temperature by direct action on the 
therm ogenetic centres. Guaiacol is also an antiseptic. 

The carbonate when given internally is antipyretic, and, being 
decomposed in the small intestine into pure guaiacol and carbonic 
acid, acts as a local antiseptic upon the alimentary canal. 

For what purposes are they employed ? 

They are much used as substitutes for creasote in the treatment 
of pulmonary tuberculosis, acute or chronic, especially in the first 
and second stages of the disease. In suitable cases it lessens the 
fever, improves the appetite and digestion, and moderates the cough. 

By some "it is believed that it forms compounds in the blood 
with the toxins produced by the presence of the bacillus tuberculosis 
in the organism, and that it aids in eliminating them from the 
system. ' ' It may be used internally, either by inhalation or by hypo- 
dermic injection, or it may be applied locally. The internal use of the 
carbonate is probably to be preferred in these cases. 

In typhoid fever as an antipyretic when the cold bath cannot be 
employed or is contraindicated, and as an intestinal antiseptic, guaiacol 
is very useful, employed locally and given internally in the form of 
the carbonate. 

It has also been used as an antipyretic in other acute infectious 
diseases accompanied with high temperature, as in pneumonia, in- 
fluenza, erysipelas, etc., and has been used for its diaphoretic action 
in pleurisy with effusion, as a means of promoting absorption. 

As an analgesic it has been successfully used in sciatica and in 
various neuralgice painted over the painful areas, and has also been 



88 ESSENTIALS OP MATERIA MEDICA AND THERAPEUTICS. 

used locally in arthritis deformans as a pain-relieving agent. In the 
latter affection the author has not seen the beneficial effects which 
have been produced by this agent in the hands of other physicians. 

In acute rheumatism with high fever its local application in selected 
cases is of value. 

It has also been used locally in follicular tonsillitis, and while not 
curative, will relieve the pain and enable the patient to swallow 
more easily. In gonorrhoeal epididymitis painted over the scrotum 
it is said to relieve the pain quickly. 

It has also been recommended as a local anaesthetic in dental and 
minor surgical procedures. 

It is used as an inhalation in fetid bronchorrhoea and in gangrene 
of the lung. Dose of guaiacol Hliij-v (0.18-0.3) four times a day 
in capsule, pill, or in solution in oil or alcohol. Hypodermically 
gr. j-iv (0. 06-0. 2) in sterilized oil maybe used. The smaller dose 
should always be administered at first and gradually increased. 

Locally ttlv-xI (0.3-2.0) may be employed. When used in this 
manner the skin should be thoroughly cleansed and the guaiacol 
applied with a camel's hair pencil and rubbed in until absorbed. 
The surface should then be covered with oiled silk or paraffin paper 
to prevent evaporation. 

As an inhalation ntv-x (0.3-0.6) in a pint of hot water may be 
used, or an oxygen inhaler may be employed. 

Guaiacol carbonate is preferable for internal administration, as it 
is free from the odor and taste of guaiacol, which are objectionable to 
many persons, and does not irritate the alimentary canal. It is used 
in tuberculosis and typhoid fever. Dose gr. v (0.3) t. i. d. in cap- 
sules increased gradually until gr. xlv (3.0) are taken in divided 
doses in 24 hours. 

What other antipyretics are occasionally used ? 

Resorcin ; hydroquinone ; pyrocatechin ; chinoline ; thalline, and 
kairine, of which only the first is official. 

Describe their effects and uses. 

Resorcin (resorcinum), hydroquinone, and 'pyrocatechin are 
isomers, being respectivery meta-, para-, and ortho-oxyphenol. 

Locally they are antiseptic and antifermentative. Internally they 
reduce febrile temperature and cause profuse diaphoresis, followed 



ANTIPYRETICS— CHINOLINE, KATRINE, THALLINE. 89 

by a more or less well-marked chill and gradual return of the fever. 
Fulness of the head or headache, flushed face, and tinnitus auriuni 
accompany these eifects ; the pulse and respiration are at first accel- 
erated but soon depressed. Large doses given to animals cause 
tremor, epileptiform convulsions, weak and rapid pulse, and finally 
failure of respiration. They are eliminated by the urine. 

Chinoline is antiseptic and antipyretic, acting very similarly to 
resorcin. It depresses the heart and respiration, and paralyzes the 
reflex centres. 

Katrine is also antipyretic, often causing much depression and 
acting dangerously on the blood. 

ThalUne is a synthetically prepared alkaloid used in the form of 
sulphate or tartrate. It is antipyretic, but causes profuse diaphoresis 
with, sometimes, dangerous depression almost amounting to collapse. 

These substances have been used in all cases of high temperature 
as antipyretics, but have been superseded by newer and less danger- 
ous drugs. 

Resorcin is used locally as an antiseptic, analgesic, and caustic. In 
purulent and offensive discharges from the nose, ears, or vagina an 
injection of the strength of gr. x-xx (0.64-1.29) to f£j (30.0) of 
water may be used. In chronic otitis media, it may be applied 
diluted with 7 parts of boric acid. It has also been used locally to 
the larynx in pertussis, in chronic aphonia, and to stimulate chronic 
ulcers of the larynx. In the form of ointments varying in strength 
from 1-50 per cent, it has been used in chronic cutaneous diseases, 
especially those of bacterial origin. 

Of resorcin the dose is gr. v-xxx (0.32-2.0) in solution ; of hydro- 
quinone and pyrocatechin gr. ij-x (0.13-0.64); of chinoline gr. 
vii-xv (0.32-1.0) in solution in oil; ofkairine gr. vij-xx (0.32-1.3) ; 
and of thalline gr. ij-xv (0.13-1.0) in pills or capsules. 



90 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 



Class II. — Medicines acting on the body by their 
effects on the various organs. 

(A) ON THE NERVOUS SYSTEM. 

ORDER I.— Hypnotics. 

What are hypnotics ? 

Hypnotics are remedies which are administered to induce sleep. 
Most of them are narcotics, or remedies which by a stupefying effect 
on the nerve centres, diminish our relationship with external nature ; 
and many of them are also anodynes, or remedies which by lessen- 
ing the excitability of the nerves and nerve centres, tend to relieve 
pain. 

How do hypnotics act ? 

As during sleep the functional activity of the hrain is depressed, 
while the nutritive function is active, and as it is necessary for the 
nutrition of an organ that the hlood should pass through the capilla- 
ries in a slow, steady and continuous stream, removing the waste pro- 
ducts and giving up substances capable of replacing the tissue de- 
stroyed, while (hiring functional activity the blood is in larger 
amount, hurried through the vessels (which are dilated) in a tumul- 
tuous manner, and does not remove the waste as fast as it accumulates 
in the tissues, therefore a medicine to cause sleep must depress the cere- 
bral functions or regulate the blood supply to the brain by either contract- 
ing its vessels or by determining more blood to other portions of the 
body. 

Name the principal hypnotics. 

Opium and its alkaloids ; chloral ; chloralamide ; chloralose ; the 
bromides; hyoscine ; sulphonal; trional; tetranal ; paraldehyd; 
urethan ; cannabis Indica ; humulus, and lactuearium. 

OPIUM. 

What is opium ? 

Opium is the concrete milky exudation of the unripe capsules of 
Papaver somniferam (Nat Ord. Papaveracese), a native of Persia, 
but cultivated throughout the civilized world. 



HYPNOTICS — OPIUM. 91 

WTiat are its principal chemical ingredients ? 

It contains the following alkaloids : Morphine, narcotine, codeine, 
narceine, paramorphine (thebaine), papaverine, pseudomorphine, 
landaniine, hydrocotarnine, cryptopine, porphyroxine, meconine and 
others. 

These are in combination with meconic and thebolactic acids. 

What are the chemical tests for the presence of opium ? 

With even very diluted solutions of opium, ferric chloride or sul- 
phate produces a blood-red ferric meconate. With morphine and 
its salts, ferric chloride or sulphate gives rise to a deep blue color, 
while concentrated nitric acid strikes with them a rich orange-red, 
slowly fading to yellow. 

What are the physiological actions of opium ? 

Opium is hypnotic, anodyne, antispasmodic and diaphoretic. It 
also depresses the circulation and respiration. A moderate dose at 
first slightly stimulates, then calms, and finally depresses the cere- 
bral functions, consciousness finally being lost in sleep, which is 
often disturbed by dreams ; the reflex centres are depressed, and if 
the dose be toxic, finally paralyzed, death occurring from paralysis 
of the respiratory centre. The pupil is contracted from stimulation 
of the 3d pair of nerves. It depresses the cardiac motor ganglia, 
the pulse becoming slower and fuller and the arterial tension ele- 
vated. Respiration is slowed. The secretions are all diminished, 
except that of the skin, which is increased. Peristalsis is retarded. 
Elimination takes place chiefly through the kidneys. Occasionally, 
intense itching of the skin, and sometimes cutaneous rashes occur. 
Headache, nausea and constipation commonly follow a medium dose 
of opium. 

What are the symptoms and treatment of opium poisoning ? 

The symptoms of opium-poisoning may be divided into tbree 
stages : 

The first stage — not always present, and when present usually of 
short duration — in which there is mental exhilaration or excitement, 
with some confusion of ideas ; a sensation of heat and often itching 
of the nose and face ; a dry skin ; and sometimes nausea and vom- 
iting. This quickly passes into 

T/ir second stage, in which there is overpowering drowsiness, pass- 



92 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

ing into stupor ; contraction of the pupils ; dryness of the mouth 
and throat ; sweating ; full, regular respirations, diminishing in fre- 
quency as the poisoning proceeds ; and congested face. This stage 
gradually passes into 

The third stage, with deepening coma ; minutely contracted pupils 
(pin-point pupils); very slow, stertorous breathing ; abolition of 
reflexes ; pale, cyanosed face ; rapid, feeble circulation, and death 
from respiratory failure. 

Before death occurs the pupils often become widely dilated. 

Death has resulted, in an adult, from morphine gr. |-, hypodermic- 
ally (rare), and from opium gr. ivss (rare). Children are very sus- 
ceptible to its action. 

Treatment. — (1) Remove any poison present in the stomach by 
the stomach pump or emetics (zinc sulphate gr. xx-xxx, or cupric 
sulphate gr. v-x in a glass of tepid water, or apomorphine gr. T V, 
hypodermically) ; (2) Catheterize the patient to prevent resorption 
of the opium from the urine ; (3) Maintain respiration and circula- 
tion by hypodermics of atropine sulphate gr. ■£-$, repeated in half 
the amount at the end of 15 to 30 minutes if necessary, the guide 
to its administration being the respiration. Strychnine, caffeine or 
cocaine are also recommended. Faradization, cold effusions and arti- 
ficial respiration are useful. Potassium permanganate has been, of 
recent years, strongly recommended as an antidote to opium-poison- 
ing. While it is not probable that it can act on the opium after the 
latter has been absorbed, yet it is well to employ a solution of the 
permanganate in washing out the stomach. 

Post-mortem examination shows no characteristic changes in the 
organs. 

How does the action of its alkaloids differ from that of 
opium ? 

The action of morphine differs from opium in that the former is 
less constipating, less of a diaphoretic, and about four times more 
powerful in other respects. Codeine is uncertain as an anodyne and 
hypnotic, but appears to possess a sedative effect on the vagus, thus 
quieting cough and bronchial irritation. The results of experiments 
with the other alkaloids are so conflicting that no reliance can be 
placed in them. 



HYPNOTICS — OPIUM. ( J3 

In what diseases is opium used medicinally ? 

As an anodyne opium or morphine is used in almost all diseases 
of which pain is a prominent and persistent symptom, and is only 
contraindicated when acute inflammation of the brain is present. 

As a hypnotic in delirium tremens (often combined with the 
bromides or chloral) and in sleeplessness of fevers and other acute 
diseases ; to allay irritation, especially when accompanied with 
painful spasm, as in the various forms of colic or in asthma (mor- 
phine hypodermically) ; in severe acute vomiting (by suppositories) ; 
to check morbid discharges or restrain peristalsis, as in cholera, diar- 
rhoea, dysentery, and enteritis. In peritonitis for the latter effect 
and as an anodyne, large doses are required, a tolerance to opium 
being established. 

In puerperal septiccemia, to support the system and as an anodyne 
it is of great value. As a motor depressant in cerebrospinal fever 
very large doses are tolerated ; also in urccmic convulsions (dangerous 
if the renal structure is much diseased), puerperal eclampsia, tetanus, 
hydrophobia and other affections with increased excitability of the 
reflex centres. In the early stages of various inflammations, for its 
influence on the circulation and tendency to retard effusion and re- 
lieve pain, and as a diaphoretic (Dover's powder) in muscular rheu- 
matism, the early stages of acute catarrhs, etc. , it is much employed. 
In diabetes opium and codeine are most reliable drugs to decrease 
the amount of sugar in the urine. Great caution should be exer- 
cised in prescribing opium in chronic diseases, as the opium-habit 
is almost certain to result. Locally opium is applied in solution as 
anodyne and sedative. 

What are the preparations and doses of opium and its alka- 
loids? 

Opii Pulvis [powdered opium) contains not less than 13 nor 
more than 15 per cent, of morphine. It is used in making the 
other preparations. 

Opium Deodoratum {deodorized opium) contains 14 per cent, of 
morphine; dose gr. ss-ij (0.032-0.130). 

Pilule Opii {opium pills), each pill contains of powdered opium 
gr. j (0.065). 

Extractum Opii [extract of opium), dose gr. ss (0.032). 



94 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Emplastrum Opii (opium plaster) contains the extract with Bur- 
gundy pitch and lead plaster. 

Trochisci Glycyrrhiza et Opii {troches of glycyrvhiza and 
opium — Wistar 's cough lozenges)', each lozenge contains of extract 
of opium gr. 2V (0.003). Very useful in laryngeal and pharyngeal 
coughs. 

Pulvis Ipecacuanha et Opii (powder of ipecac and opium- 
Dover s powder) is a diaphoretic and anodyne; dose gr. x (0.648), 
containing of opium and ipecac each gr. j (0.06) with sugar of 
milk. 

Tinctura Opii [tincture of opium — laudanum), dose ttlxij or 25 
drops (0.74). 

Tinctura Opii Deodorati (tincture of deodorized opium), dose 
"Uij (0.74). 

Tinctura Opii Camphorata (camphorated tincture of opium — 
paregoric) contains opium, diluted alcohol, oil of anise, benzoic acid, 
glycerin, and camphor; dose f3j-iv (3.696-14.786). To a young 
child gtt. iij-xx (0.185-1.232), according to age. 

Tinctura Ipecacuanha et Opii (tincture of ipecac and opium). 
This is Dover's powder in a fluid form. Dose nvxij-xx (0.74-1.232). 

Acetum Opii (vinegar of opium — black drop), dose ttlxij (0.74). 

VlNUM Opii (wine of opium — Sydenham' s laudanum), dose 
ntxij (0.74). 

Morphina Sulphas (morphine sulphate) ; Morphina IIydro- 
CHLORAS (morphine hydrocMorate) ; MORPHINA Acetas (morphine 
acetate). The salts are preferred to the pure alkaloid because they 
are more soluble. Dose of either gr. ?;-] (0.010-0.016) is equal to 
opium gr. j (0.065). They are well adapted to hypodermic use. 

Pulvis Morphina Compositus (compound powder of morphine 
— Tullys powder) contains of morphine sulphate 1 part, with 20 
parts each of camphor, liquorice, and calcium carbonate ; dose gr. 
v-xv (0.324-0.972). 

Trochisci Morphina et Ipecacuanha (troches of morphine 
and. ipecac). Each lozenge contains of morphine sulphate gr. - 4 J o, 
(0.0016) and of ipecac gr. ^ (0.005). 

Magendieh solution (not official) contains of morphine gr. xvj to 
the ounce. It is sometimes used hypodermically, but it is better to 
make a fresh solution of morphine for each injection, as bacteria 



HYPNOTICS— OPIUM. 95 

frequently develop in solutions of the alkaloids when kept for some 
time, and also because otherwise there is some risk of confusion, as 
the French Magendie's solution contains about gr. xijss to the ounce. 
Also the solutions of morphine official in the British Pharmacopoeia 
do not correspond in strength to either of the above solutions. 
Codeina (codeine), dose gr. i-ij or even gr. v (0.016-0.130-0.32). 

What medicines are incompatible with opium ? 

The alkalies precipitate morphine from solutions of opium and 
vegetable infusions containing tannic acid form a less soluble t annate 
of morphine ; many mineral salts are also decomposed by solutions 
of opium. 

How is opium administered ? 

Opium is often administered in the form of the officinal prepara- 
tions, either alone or combined with other substances. The bro- 
mides, chloral or other hypnotics are often added to increase its 
soporific influence ; belladonna, etc. , to enhance its anodyne effects ; 
lead or other astringent to act more powerfully in intestinal dis- 
orders ; potassium nitrate, or minute doses of antimony, to increase, 
while atropine is often combined with morphine to diminish, its 
action as a diaphoretic. It may be administered by the mouth or 
rectum (suppositories or laudanum enemata), and its alkaloids may 
also be given hypodermically. 

CHLORAL. 

What is chloral ? 

Anhydrous chloral is an oily liquid made by saturating absolute 
alcohol with dry chlorine gas, and is tridWora/fdehyd. By uniting 
with water, a hydrate, the official chloral, is formed, which occurs 
as a crystalline solid. 

What are its physiological effects? 

Locally applied, chloral is antiseptic and irritant. Given inter- 
nally, it is a hypnotic, motor depressant and cardiac sedative. In 
medicinal doses, it causes quiet, natural sleep, contraction of the 
pupil and deep, regular breathing. After large doses, the sleep is 
deeper and may even pass into coma, respiration is slowed, the car- 
diac action is weakened and diminished, the temperature falls, and 
sensibility and reflex action are depressed. It is not an anodyne. 



96 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Nausea and vomiting sometimes occur from its irritant action on the 
mucous membrane, and in some persons excitement and even 
delirium may take the place, of the sleep which it usually produces. 
The continued use of chloral causes chloralism or the chloral habit, 
and produces an anaemic condition, with weak, irregular heart, 
irritable temper and loss of self control : a state similar to delirium 
tremens has been observed. 

What are the symptoms and treatment of chloral poisoning ? 

After toxic doses, profound narcosis, great muscular relaxation, 
slow and very weak pulse, diminished frequency of breathing, marked 
contraction of the pupil and lividity of surface, with great reduction 
of body heat, occur. Death is due to paralysis of respiration or to 
sudden failure of the heart from paralysis of its motor ganglia. 

The smallest recorded fatal dose is gr. xxx (2.0). 

The treatment for chloral poisoning consists in (1) maintaining the 
temperature by artificial heat ; (2) maintaining the cardiac action by 
atropine in small doses, repeated as required, and (3) maintaining 
the respiration (partly by the atropine or by morphine, and partly 
by artificial manipulations). While chloral is the best antidote for 
strychnine poisoning, the converse does not hold good. 

What are its therapeutical uses? 

As a hypnotic, chloral is employed in insomnia, hysterical or 
maniacal excitement, and in delirium tremens and mania-a-potu, 
but is contraindicated in any condition where the heart is weak or 
has undergone fatty degeneration. As a motor depressant in urcemic, 
infantile or puerperal convulsions, in tetanus, and in poisoning by 
strychnine, it is of great service, and has been used in whooping- 
cough and chorea. It is also recommended in sea-sickness (gr. v 
t. d. ) and to relax a rigid cervix during the first stage of labor. 
Locally, in diluted solution, it has been used as an anodyne and 
antiseptic dressing, and, triturated with equal parts of camphor, it 
forms a valuable liniment in neuralgic and muscular pains. 

How is chloral administered? 

The dose of chloral is gr. ij-xx (0.130-1.296), which may be 
repeated in an hour or two if sleep is not produced. It is better 
given in syrup. It should not be given with alkalies, which decom- 
pose it, chloroform and formic acid being formed. 



HYPNOTICS— THE BROMIDES. 97 

What is croton-chloral hydrate? 

Croton-chhral hydrate (not official), or butyl-chloral hydrate, is 
made by the action of chlorine gas on ethylic aldehyd, and occurs in 
small, glittering crystals. Its effects and uses are similar to those of 
chloral, and as it possesses a very decided anaesthetic influence over 
the filaments of the trigeminii, it is much used in the neuralgiae 
affecting the branches of these nerves. Dose gr. v-xx (0. 324-1.296), 
in glycerin or syrup. 

CHLORALAMIDE. 

What is chloralamide? 

Chloralamide (not official) is a compound prepared by the action 
of formamide upon chloral. It is soluble in water, but more so in 
alcohol. Its action is similar to that of chloral, but it is not so 
certain a hypnotic, and neither depresses the heart nor irritates 
the stomach and kidneys to the same extent as does the latter drug. 
It is excreted as urochloralic acid. 

Occasionally, after the exhibition of large doses, it causes slight 
poisoning, the symptoms being chilliness followed by a sensation of 
heat, sweating, arrhythmia, nausea, and sometimes vomiting, with 
respiratory depression. These symptoms are rarely severe and 
usually pass off rapidly. 

It is used as a hypnotic and nervous sedative in the same condi- 
tions for which chloral is prescribed, and is especially useful in 
insomnia due to nervous causes, but fails usually when insomnia is 
due to pain. It is also recommended in sea-sickness. 

Dose gr. x-xxx (0.65-2.0) given in capsule or solution one hour 
before its effects are desired. It may be administered by the 
rectum. 

CHLORALOSE. 

What is chloralose ? 

Chloralose (not official) is formed by heating a mixture of anhy- 
drous chloral and glucose. 

It occurs as fine white crystals having an unpleasant, rather sharp 
taste, and being readily soluble in hot water and alcohol, but only 
slightly soluble in cold water. 

While it appears to be a reliable hypnotic, it induces toxic symp- 
toms readily, apparently by increasing the reflex excitability of the 
7 



98 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

medulla oblongata, and would at present seem rather difficult to 
handle, as the toxic dose varies with different individuals, and is 
smaller in nervous and hysterical patients and in alcoholic subjects. 

In sufficient doses general convulsions are produced, frequently 
accompanied by involuntary urination. 

The toxic symptoms rapidly disappear on discontinuing the drug 
and appear to leave no serious consequences behind them. It has 
been used as a hypnotic and analgesic. 

Dose gr. ij-iij or iv (0. 13-0. 2-0. 25), always beginning with the 
smaller dose. 

THE BROMIDES. 

What are the physiological effects of the bromides ? 

The bromides are hypnotic and depressors of the reflex spinal centres. 
Applied locally to the pharynx, they diminish its reflex irritability. 
Given internally they cause drowsiness and often sleep by inducing 
a condition of cerebral anaemia, depress the reflex spinal centres and 
the functions of the end-organs of peripheral nerves, thus lessening 
nervous irritability, reflex activity and cutaneous sensibility. They 
also depress the functions of the sympathetic nervous system . In 
very large doses potassium bromide lessens the cardiac frequency and 
force, lowers the arterial tension (while contracting the blood vessels), 
and finally in animals paralyzes the heart in diastole. This seems to 
be due to the potassium only (which is a cardiac and nerve poison), 
for the other bromides do not arrest the cardiac action. They slow 
the respiration and lower the temperature of the body. They are 
eliminated by the kidneys, skin and mucous membrane. 

What is bromism ? 

When taken for a long time they induce a condition known as 
bromism, the symptoms of which are acne, anaemia, drowsiness, 
defective memory, malaise, impaired reflexes, malnutrition, loss of 
sexual power and desire, and often a tendency to melancholia. 
These symptoms pass away when the drug is discontinued. No 
case of acute poisoning is on record. 

What are the medicinal uses of the bromides ? 

They are used as hypnotics in all forms of insomnia due to cerebral 
hyperemia, but are contraindicated when anaemia is present. In 



HYPNOTICS — THE BROMIDES. 99 

the early stages of delirium tremens they are of great service. They 
are also given as depressor motors in local or general convulsions as 
chorea, urcemic, puerperal, hysterical or infantile convulsions, tetanus, 
and as an antidote to strychnine poisoning (inferior to chloral). In 
the treatment of epilepsy they rank among the best remedies. 
In reflex vomiting, as of sea-sickness or pregnancy, they are of use. 
In whooping cough ammonium bromide is often efficacious. In mi- 
graine they are sometimes beneficial. For their influence over the 
sexual functions they are used to control nymphomania, priapism, 
and masturbation. Conjoined with ergot they are used to decrease 
the uterine blood supply in menorrhagia, and are of utility in sub- 
involution of the uterus. Strontium bromide is said markedly to 
diminish the amount of sugar in the urine in glycosuria. 

What are the official bromides ? 

Potassii Bromidum {potassium bromide), dose gr. v-3j (0.32- 
4.0). 

Ammonii Bromidum {ammonium bromide) has less influence on 
the circulation, respiration, and temperature than the potassium salt ; 
dose gr. v-xxx (0.32-2.0). 

Sodii Bromidum {sodium bromide), dose gr. v-3j (0.32-4.0). 

Calcii Bromidum {calcium bromide), dose gr. v-3j (0.32-4.0). 

Zinci Bromidum {zinc bromide), dose gr. j-x (0.065-0.648) (not 
much used). 

Strontii Bromidum {strontium bromide), dose gr. iij-x (0.2-0.6). 

Acidum Hydrobromicum Dilutum [diluted hydrobromic acid), 
containing 10 per cent, of the absolute acid, is said to possess similar 
effects to the bromides. It is chiefly used as a hypnotic, and added 
to quinine mixtures to prevent cinchonism. Dose f3ss-j (2.0-4.0). 

What medicines are incompatible with the bromides ? 

Acids and the acidulous and metallic salts are chemically incom- 
patible with the bromides. They are antagonized by cardiac and 
vaso-motor stimulants. 
How may they be administered ? 

They may be given in powder or in solution in syrup. Zinc bro- 
mide may be used in pilular form. They are often given together 
in small doses, and to enhance their hypnotic effect may be com- 
bined with opium or its alkaloids, chloral or cannabis indica. 



100 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
HYOSCINE HYDROBROMAS. 

What is hyoscine hydrobromate ? 

Hyoscine is one of the alkaloids found in Hyoscyamus niger, or 
henbane (q. v. ). It is an efficient hypnotic when used hypoderm- 
ically, and is employed in the form of hydrobromate in acute mania, 
alcoholic delirium, and hysteria. Dose gr. gV (0.0008) by the mouth, 
or hypodermically gr. -^ (0.0005). 

PARALDEHYDUM. 

What is paraldehyd ? 

Paraldeliyd is a colorless liquid with a disagreeable odor and 
taste, prepared by heating ethyl aldehyd with a mineral acid or 
with zinc chloride. 

What are its physiological actions ? 

In medicinal doses paraldehyd produces sleep closely simulating 
natural sleep, without affecting the cardiac action. It depresses the 
reflex centres, especially those of the upper part of the cord, and in 
toxic amounts depresses and finally paralyzes the respiratory centre, 
diminishing the amount of carbonic acid exhaled, and lowering the 
body temperature. It has no anodyne virtues. It often irritates the 
mucous membranes, and cutaneous eruptions sometimes follow its use. 
What are its medicinal uses and dose ? 

It may be given as a hypnotic, where sleeplessness is not induced 
by pain, as in delirium tremens, hysteria, etc. As a reflex depressor it 
has been employed in epilepsy, and in animals poisoned by strych- 
nine has proved antidotal. It is given in doses of f3j (4.0), and 
should be freely diluted. 

SULPHONAL. 

What is sulphonal ? 

Sulphonal or dional (not official) is a substance prepared synthet- 
ically and described chemically as diethylsulphon-dimethylmethane. 
It occurs as heavy, prismatic crystals, colorless, odorless, and nearly 
tasteless, and is soluble in 100 parts of cold water, but freely soluble 
in hot water and also in ether and alcohol. 
What are its physiological and its toxic effects ? 

The physiological action of sulphonal is not thoroughly under- 
stood. It acts chiefly on the cerebral centres, depressing them and 



HYPNOTICS — SULPHONAL. 101 

causing sleep. Sometimes, especially after large doses have been 
taken, it depresses the reflexes, disorders digestion, and causes 
cutaneous eruptions. In large doses it depresses respiration, render- 
ing it slow, weak, and, when excessive doses have been taken, ster- 
torous, and finally producing death by cessation of the respiratory 
act. 

It has but little effect on the circulation, and experimenters differ 
as to its effect upon the blood, the majority believing that it causes 
no change in that fluid which can be detected by chemical or spectro- 
scopic analysis. 

It is probably eliminated in great part by the urine, and frequently 
changes the color of that excretion to a reddish-brown — a change 
supposed to be due to the presence of haematoporphyrin, although 
the coloring-matter differs from the latter on spectroscopic analysis. 

Disagreeable after-effects sometimes follow the use of sulphonal, 
as drowsiness, giddiness, headache, and occasionally incoordination 
of gait, sometimes cutaneous eruptions or disordered digestion, per- 
haps nausea and vomiting, occur. 

Sulphonal is by no means an absolutely innocuous drug, and death 
has resulted from large doses in many recorded cases, from respira- 
tory failure. 

The symptoms of poisoning are various, the most common being 
drowsiness, stupor, muscular incoordination, mental and physical 
hebetude, depression of reflexes, nausea and vomiting, and usually 
constipation. Sometimes ataxic nervous symptoms, "diplopia, 
muscular tremor or paresis, ptosis, oedema of the eyelids, slow and 
weak (possibly stertorous) respiration, slow pulse, elevation of tem- 
perature, general anaesthesia, urine changed in color to reddish- 
brown, diminished in quantity or suppressed, aphasia, and cyanosis" 
(M. L. Foster). 

In several cases with recovery which the author has seen the 
symptoms were drowsiness almost amounting to stupor; mental 
hebetude ; slow speech ; slight hallucinations ; slow, shallow respi- 
ration ; slow, weak pulse, and staggering gait with slight cyanosis. 
In non-fatal cases recovery is usually rapid. Sulphonal is cumula- 
tive in its action. During its administration it is of the utmost 
importance that the bowels should be made to act daily (Schulz) 
and that the urinary secretion should be abundant. 



102 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

If symptoms of poisoning appear, the drug should at once be 
discontinued ; the bowels should be freely opened, saline diuretics 
administered, and the patient kept in the recumbent position. If 
there is much depression of the circulation or respiration, stimulants 
may be administered. 

What are its therapeutic uses ? 

Sulphonal is much used as a hypnotic and cerebral sedative in 
nervous insomnia, and even in melancholia, delirium tremens, and 
acute mania. In the insomnia of low fevers, as that of typhoid fever, 
it sometimes gives good results. 

It has been recommended as a sedative reflex depressant in asthma, 
hiccough, trismus neonatorum, and in convulsions due to dentition, 
and has even been used in epilepsy and chorea. It is said that in 
small doses (gr. viij (0.5)) it is effective in arresting the night-sweats 
of phthisis, and that in diabetes it will temporarily diminish the 
amount of sugar excreted in the urine. 

It is said to be contraindicated in angina pectoris. Dose gr. 
v-xxx (0.3-2.0), which may be given in capsules, but is better 
administered dissolved in hot water or milk, two hours at least 
before the time when its effects are desired. 

As it is cumulative in its action, it is better not to give more than 
gr. xxx (2.0) in 24 hours. 

TRIONAL. 

What is trional ? 

Trional (not official) is a sulphone differing from sulphonal in that 
it contains one atom more of carbon and one less of hydrogen than 
the latter. Its chemical name is diethylsulphon-methylethylmethane. 

It occurs as white, odorless, almost tasteless crystals, not very 
soluble in cold, but readily soluble in boiling water, and also in 
alcohol and milk. 

What are its effects and uses ? 

Trional is a hypnotic, acting more quickly than sulphonal, being 
easily decomposed in the body, sometimes slightly lowering the 
pulse and blood-pressure, and rarely leaving any disagreeable after- 
effects. It is not cumulative. Occasionally after its long-continued 
use the urine is colored reddish-brown from the presence of haemato- 
porphyrin. 



HYPNOTICS — TETRONAL. 103 

Toxic doses given to animals cause death from respiratory 
paralysis. 

Occasional after-effects are loss of appetite, epigastric pain, 
nausea and vomiting, vertigo, and unsteadiness of gait. These 
symptoms usually soon disappear. 

It is supposed to act directly on the cerebral cortex. 

Several cases of acute poisoning by trional have been reported ; the 
symptoms being drowsiness, staggering gait, vertigo, vomiting, diar- 
rhoea, loss of muscular power, and lowered temperature, sometimes 
attended with rapid pulse and respiration, excitement, and collapse. 

Trional is used as a hypnotic in insomnia due to organic cerebral 
affections, neurasthenia, or other functional psychosis, worry or 
mental over-work. 

As a sedative in cerebral excitement it is decidedly inferior to 
tetronal, and in sleeplessness due to pain it usually fails entirely. 

It is a " safe and efficient hypnotic for children " when pain is not 
present (Claus). 

It has also been recommended in epilepsy, either alone or com- 
bined with the bromides. 

Dose xv-xxx (1.0-2.0) about half an hour before its effect is 
desired. 

If it is administered for any length of time, it is better to intermit 
the dose occasionally, in order to guard against any possible cumula- 
tive effect, and it is important also to insure a daily evacuation of 
the bowels. 

TETRONAL. 

What is tetronal? 

Tetronal (not official) belongs chemically to the disulphone group, 
to which also sulphonal and trional belong. It is diethylsulphon- 
diethylmethane. These three products differ from each other chem- 
ically only in the number of molecules of ethyl and methyl which 
they contain. Thus sulphonal contains two molecules each of ethyl 
and of methyl, and is sometimes spoken of as dional ; trional con- 
tains three molecules of ethyl and one of methyl, and tetronal con- 
tains four molecules of ethyl and none of methyl. 

Tetronal is formed synthetically, and occurs in colorless, shining 
plates, without odor or taste, soluble in about 500 parts of cold, 
more soluble in hot water ; soluble also in alcohol and in ether. 



i04 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are its effects and uses ? 

Its effects and uses are similar to those of trional, but it has a more 
decided sedative effect. Occasionally its administration is followed 
by disagreeable after-effects, as headache, anorexia, nausea, vomit- 
ing, vertigo, and even incoordination. 

It is not decomposed in the system, and is excreted under its own 
form in the urine. 

Dose gr. v-xv (0.3-1.0), repeated in an hour if necessary. The 
best vehicle for its administration is hot milk. 

When given for a length of time it is better to intermit its use 
every 3d or 4th night. 

URETHAN. 

What are the effects and uses of urethan ? 

Urethan (not official) or ethyl carbamate is a synthetical product 
formed by the interaction of ethyl carbonate and ammonia, or by 
that of urea nitrate and ethyl alcohol, and occurs in crystalline 
masses readily soluble in water and alcohol. In medicinal doses it 
causes tranquil sleep, preceded by a short period of excitement. It 
depresses the reflex centres, at first quickens but soon slows the 
respiration, and somewhat reduces the temperature, and in over- 
doses causes, in animals, death from respiratory paralysis. The 
effect upon the heart is disputed. It is not analgesic. It has been 
used as a hypnotic in simple insomnia with varied success, and 
appears to be more applicable to cases where the action of chloral 
on the heart contraindicates the use of that agent. As a motor 
dqvessant it has been employed in tetanus, infantile convuhio?is, 
and puerperal eclampsia. Dose gr. ij-xxx (0.130-2.0). It has been 
used locally as an antiseptic dressing for wounds. 

CANNABIS INDICA— INDIAN CANNABIS. 

What is this drug ? 

Cannabis Indica is the flowering tops of the female plant of C. 
sativa or hemp {Nat. Ord, Urticaceae), grown in the East Indies. 

What are the active chemical constituents of hemp ? 

The alcoholic extract contains a resin (cannabin) and a volatile oil. 
It is claimed that several alkaloids have been discovered, but their 
existence is, as yet, doubtful. 



HYPNOTICS — CANNABIS INDICA. 105 

What are the physiological actions of cannabis ? 

In full 'medicinal doses it at first stimulates and then depresses the 
cerebro-spinal functions without affecting respiration or circulation 
to any marked extent. The mental exhilaration is usually of a 
pleasurable kind, the pupils are dilated, ideas flow rapidly and con- 
ception of time and space are so altered that seconds seem hours 
and objects a few feet off seem miles away ; an active, busy delirium 
usually occurs and sometimes increase of the sexual appetite ; this is 
followed by a sense of weight in the extremities, depression of the 
reflexes, some loss of muscular power and cutaneous anaesthesia, 
succeeded by sleep. It increases but does not originate uterine con- 
tractions. No fatal case from its use is recorded. 

What are its therapeutic uses ? 

It is used as a hypnotic in mania and in mania-a-potu ; as an 
anodyne in neuralgia, migraine, dysmenorrhcea, rheumatism, and 
gout, and to relieve pain in acute and chronic Bright 's disease; as 
an antispasmodic in tetanus, chorea, hysteria, and spasm of the neck 
of the bladder ; as an addition to cough medicines to allay irritation 
of the throat, and to promote a condition of euthanasia in the later 
stages of phthisis. It is highly recommended in dysentery, and is 
of undoubted service in checking uterine hemorrhages not due to 
abortion or following labor. In sexual impotence, when functional, 
it is sometimes of use. In gonorrhoea it is said to lessen the dis- 
charge and prevent chordee. As a local application it enters into 
the composition of many corn-cures. 

What are its preparations and doses ? 

Extractum Cannabis Indkle {extract of cannabis Indica), 
dose gr. f-j (0.016-0.065). 

Extractum Cannabis Indict Fluidum (fluid extract of can- 
nabis Ind'tca). dose n\j-x (0.06-0.6). 

Tinctura Cannabis Indict [tincture of cannabis Indica), dose 
nixxx (2.0). In using a new sample of cannabis Indica always 
begin with the minimum dose, as different samples vary much in 
strength. 



106 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 
HUMULUS. 

What are the effects, uses, preparations, and doses of humu- 
lus? 

Humulus is the strobiles of H. lupulus or hop vine {Nat. Ord. 
Urticaceae). Lupulin is a yellow powder found near the base of 
the strobiles. It contains a volatile oil, choline (formerly called 
lupuline, a strongly alkaline liquid), lupamaric acid (a bitter princi- 
ple), resin, etc. 

Hops are tonic, very feebly narcotic, anaphrodisiac, and diuretic. 
They are used as a hypnotic in mild forms of delirium tremens, and 
in restlessness and sleeplessness from overwork ; as an anaphrodisiac 
in priapism, chordee, nymphomania, and satyriasis; as an anti- 
spasmodic and sedative in hysteria and neurasthenia; as a diuretic 
and anodyne in irritation of the bladder, and locally as an anodyne 
poultice, and as a sedative injection in acute vaginitis. 

Hop pillows are a popular remedy for sleeplessness due to nerv- 
ousness. 

Tinctura Humuli (tincture of humulus), dose f3j-iv (4.0-15.0) 
or more. 

Lupulinum [lupulin), dose gr. v-x (0.324-0.648), but not much 
used in this form. 

Extractum Lupulini Fluidum [fluid extract of lupulin), dose 
f'3ss-ij (2.0-8.0). 

Oleoresina Lupulini (oleoresin of lupulin), dose ^Ix-xxx 
(0.61-2.0). 

LACTUCARIUM. 

What are the effects, uses, and preparations of lactucarium ? 

Lactucarium is the concrete milk-juice of Lactuca verosa, the 
garden lettuce (Nat. Ord. Composite), and contains lactucin, which 
is said to be even more feebly hypnotic than the crude drug. Lac- 
tucarium is supposed to possess anodyne and hypnotic powers, and 
has been used as a substitute for opium when the latter is indicated, 
but cannot, for any reason, be given. Its action, if any, is very mild. 

Tinctura Lactucarii (tincture of lactucarium), dose ttlx-f3j 
(0.6-3.6). 

Syrupus Lactucarii {syrup of lactucarium), dose f3ij-iv (8.0- 
15.0). 



MYDRIATIC ANODYNES— BELLADONNA. 107 

ORDER II. — Mydriatic Anodynes. 

What are the mydriatic anodynes ? 

The mydriatic anodynes are remedies employed as analgesics and 
antispasmodics, which possess no hypnotic effect, but cause dilatation 
of the pupil and, in large doses, a restless delirium. 

What medicines are included under this head ? 

Belladonna, stramonium, hyoscyamus, duboisa, coca, and their 
alkaloids, and antipyrine. 

BELLADONNA. 

What is belladonna ? 

Belladonna is the leaves and root of Atropa Belladonna or deadly 
nightshade {Nat. Ord, Solanaceae), a European plant, cultivated in 
this country. 

What are the chemical constituents of belladonna ? 

Its properties depend upon an alkaloid called atropine, which 
exists in the plant as a malate. Both the leaves and the root also 
contain belladonine (probably oxyatropine), hyoscyamine (sometimes 
the predominating alkaloid in the leaves and often the only alkaloid 
in young roots), and atropamine. 

What are the tests for atropine 1 ? 

A delicate test is the addition of hydrobromic acid, which pro- 
duces a yellow, amorphous precipitate, soon becoming crystalline. 
The physiological test (viz. , the dilatation of the pupil in the lower 
animals after the local application of the suspected solution) should 
always be resorted to. 

What are the physiological effects of belladonna and its 
alkaloid ? 

Applied locally to the skin, it is absorbed, lessens the sensibility 
of the sensory nerves, and produces constitutional effects. Small 
doses, administered internally, cause diyness of the mouth and 
throat, with some headache ; after larger amounts, there is difficulty 
in swallowing, from arrest of the mucous and salivary secretions, the 
pupils dilate widely, the skin becomes dry and a scarlatinoid rash 
appears, the cardiac action is accelerated, and an active delirium 
occurs. In moderate doses, they act as cerebral excitants ; larger 



108 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

doses produce hallucinations and impair the excitability of the motor 
and sensory nerves, thus producing a peculiar delirium in which 
there is a great desire for constant motion associated with lassitude. 
The spinal reflex centres are first stimulated, afterward paralyzed, if 
the amount taken be sufficiently large. It paralyzes the 3d nerves 
and stimulates the end organs of the syni pathetic, thus dilating the 
pupil whether used locally or internally ; the power of accommoda- 
tion is also paralyzed, and after large doses the intraocular tension is 
lessened. 

The cardiac action is at first slowed, if the dose be small (from 
stimulation of the inhibitory centre), but is soon much quickened 
(from progressive paralysis of the peripheral filaments of the vagus 
and stimulation of the cardio-accelerator centres or nerves). Large 
doses paralyze the cardiac muscle. Atropine stimulates the vaso- 
motor centres and raises the arterial pressure, but after toxic doses 
the arterioles dilate, from paralysis of their muscular walls, and the 
blood pressure falls. It first stimulates and then paralyzes the 
respiratory centre. The temjicrature rises after moderate doses, 
probably from stimulation of the thermo-genetic spinal centres ; but 
after toxic amounts have been taken a decided fall of temperature 
occurs, probably from vaso-motor paralysis. Small doses probably 
increase intestinal peristalsis, by depressing the inhibitory fibres of 
the splanchnics, while large doses paralyze the non-striated muscular 
fibres of the intestines and bladder. It arrests the secretions of the 
skin, mammary, salivary and muciparous glands, and probably of the 
liver and pancreas, by paralyzing the terminal filaments of the secre- 
tory nerves. The intestinal secretions are probably increased, as is 
that of the kidneys (usually). After large doses, the urine may be 
entirely suppressed. 

Atropine is eliminated principally by the kidneys. 

What are the symptoms and treatment of atropine poisoning ? 

The pupils dilate so widely that the iris can scarcely be seen ; 
swallowing is impossible, from dryness of the throat and mouth ; 
the muscular system is relaxed ; maniacal delirium occurs, with 
impaired sensation, failing pulse, quickened followed by failing respi- 
ration, stupor, coma, sometimes convulsions, diminished body heat, 
and death usually from asphyxia. The treatment consists of: (1) 



MYDRIATIC ANODYNES— BELLADONNA. 109 

evacuation of the contents of the stomach (by emetics or stomach 
pump), bowels (by cathartics) and bladder (by the catheter), to pre- 
vent further absorption of the poison; (2) giving tannic acid freely 
as a chemical antidote ; (3) giving pilocarpine, physostigmine or 
morphine hypodermically, as partial physiological antagonists, and 
(4) maintaining the circulation and respiration by electricity and 
artificial respiration. 

What are the medicinal uses of belladonna and atropine ? 

As an anodyne in the various neuralgice, either locally or given by 
the mouth, rectum or subcutaneously, it is of value, and is often 
combined with morphine. In muscular rheumatism and in myalgia 
it is also of service. In conjunctivitis and in iritis it is used locally, 
not only to dilate the pupil but to lessen pain. 

As an antispasmodic it is used to relax spasm and allay pain in 
lead colic, spasmodic dysmenorrhoza, and cramps of the bowel, 
bladder and urethra ; also to relax the rigid cervix uteri in labor. 
In asthma, in laryngysmus stridulus and whooping cough it often 
proves of use. In habitual constipation, a small amount combined 
with purgatives increases their action by relaxing spasm of the intes- 
tinal muscular layer and stimulating peristalsis. It is a valuable 
remedy in the treatment of incontinence of urine in children when 
given in doses sufficient to produce some constitutional effect. 

As a cardiac and vaso-motor stimulant in all cases of threatened 
collapse from heart failure it is advantageously employed, and has 
been highly recommended to contract the blood-vessels in acute in- 
flammatory affections generally. To check excessive secretion, as in 
salivation, excessive sweating, especially the night-sweats of phthisis, 
and in colliquative diarrhoea, it is of great value, and is a well-known 
galactafuge, being used internally and applied locally for this pur- 
pose. As a respiratory stimulant in opium poisoning atropine is of 
great service, and may be used in cases of poisoning by other sub- 
stances attended with failure of respiration. 

Locally, belladonna is used as an ointment, liniment or plaster for 
the relief of pain in neuralgia, myalgia and muscular rheumatism ; 
to allay cardiac palpitation; to relax spasmodic stricture of the 
urethra (applied on a bougie or given by suppository), and as a 
galactafuge. In ophthalmic practice a solution of atropine (gr. ^-iv 



110 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

(0.003-0.25) to water f3j (4.0)) maybe dropped into the conjunc- 
tival sac to dilate the pupil and to paralyze accommodation, so that 
an examination can be readily performed or the refraction of the 
eye determined. In various inflammations of the ocular apparatus, 
as conjunctivitis, keratitis, iritis, etc., it is used to lessen pain and 
diminish the blood-supply to the inflamed parts. 

What are the preparations and doses of belladonna ? 

Extractum Belladonna Foliorum Alcoholicum (alcoholic 
extract of belladonna leaves), dose gr. $-ss (0-008-0.032) in pill or 
suppository. 

Extractum Belladonna Radicis Fluidum (fluid extract of 
belladonna root), dose rr\J— ij (0.061-0.12). 

Tinctura Belladonna [tincture of belladonna), dose tt[v-xxx 
(0.3-2.0). 

Linimentum Belladonna [liniment of belladonna) contains 95 
per cent, of the fluid extract and 5 per cent, of camphor. 

Unguentum Belladonna [ointment of belladonna) contains 10 
per cent, of fluid extract. 

Emplastrum Belladonna [plaster of belladonna). 

Atropina [atropine), usually employed in the more soluble form 
of Atropina Sulphas [atropine sidphate), dose gr. Tho~wo 
(0.0005-0.001). 

What substances are incompatible with belladonna ? 

Alkalies precipitate atropine from solutions of belladonna, and 
tannic acid forms with it atropine tannate, a less soluble salt. 

What is homatropine hydrobromate ? 

It is a non-official salt of an alkaloid derived artificially from atro- 
pine. It differs from atropine in dilating the pupil more rapidly 
and much more transiently, in not causing much constitutional dis- 
turbance when used locally for this purpose, and in slowing, not 
accelerating, the heart's action. It is used as a substitute for atropine 
in ocular therapeutics. 



MYDRIATIC ANODYNES — HYOSCYAMTJS. Ill 

STRAMONIUM. 

What are the source, composition, action and uses of stra- 
monium ? 

Stramonium is the leaves and seeds of Datura Stramonium, thorn- 
apple, Jamestown weed or gypsum {Nat. Ord. Solanacese), a com- 
mon indigenous plant. It contains an alkaloid called daturine, iso- 
meric with atropine and having the same action. As this is the 
active principle of stramonium, the effects of the latter are identical 
with those of belladonna, and it may be used for the same purposes. 
The leaves have been made into cigarettes and smoked to avert a 
threatened paroxysm of asthma, and it has been used externally as 
a poultice or as ointment to painful ivounds, external inflamma- 
tions, hemorrhoids and fissure of the anus. The officinal prepara- 
tions (all made from the seed) are : — 

Extractum Stramonii Seminis {extract of stramonium seed ), 
dose gr. ss (0.03). 

Extractum Stramonii Seminis Fluidum {fluid extract of 
stramonium seed), dose tt\j-v (0.06-0.3). 

Tinctura Stramonii Seminis {tincture of stramonium seed), 
dose TiLv-xv (0.3-1.0). 

Unguentum Stramonii {ointment of stramonium) contains 10 
per cent, of the extract. 

HYOSCYAMUS. 

What is hyoscyamus ? 

Hyoscyamus is the leaves and flowering tops of H. niger, or hen- 
bane (Nat. Ord. Solanaceae), a native of Europe. 

What does it contain ? 

It contains two alkaloids, hyoscyamine and hyoscine (identical with 
scopolamine) both of which are isomers of atropine and daturine. 

What are the physiological effects of hyoscyamus and its 
alkaloids ? 

Hyoscyamine appears to be identical in action to its isomer atro- 
pine, but feebler and less irritant. It does not dilate the pupil as 
rapidly; sometimes retards, sometimes quickens the heart's action; 
and at first quickens, then slows the respiration. 

Hyoscine causes dryness of the mouth and throat, flushing of the 



112 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

face, sleep, slow respiration, and in large doses slow, full pulse, 
muscular weakness, incoordination, diaphoresis, and, it is said, a 
rise in temperature. The treatment of poisoning by hyoscine con- 
sists in the administration of alcoholic stimulants and coffee or 
caffeine ; in artificial respiration ; in the use of faradism, and per- 
haps the cautious use of physostigmine. 

Hyoscyamus combines the action of its alkaloids, differing from 
that of belladonna in proving hypnotic. 

What are the uses of hyoscyamus and its alkaloids ? 

Hyoscyamus has been used as a substitute for belladonna in the 
diseases in which the latter is employed. It has also been used as a 
hypnotic in various forms of insanity, in delirium tremens, and in 
hysteria. Added to purgatives it enhances their efficacy and pre- 
vents griping. 

Hyoscyamine has been found useful as a sedative to the nervous 
system in insanity ; to lessen spasm and allay pain in vesical tenes- 
mus ^ and in irritable bladder ; and, to prevent griping, as an addi- 
tion to purgatives. It has sometimes proved useful in chorea. 

Hyoscine is used as a cerebral sedative and hypnotic in maniacal 
excitement, but should only be employed temporarily, and then only 
in cases where excitement is a prominent symptom. In melancholia 
it has proved useless or injurious. Cases do not do well under its 
continued use. It may be employed to produce sleep when mor- 
phine or chloral is contraindicated in advanced renal disease and 
in cases of weak heart. To produce hypnotic effects it should be 
administered hypodermically. It has been found efficacious in 
paralysis agitans and in various forms of tremor. Disagreeable 
after-effects are rare. 

What are the preparations and doses of these substances ? 

Extractum Hyoscyami (extract of hyoscyamus), a preparation 
of uncertain strength; dose gr. j-ij (0.065-0.13). 

Extractum Hyoscyami Fluidum^mmZ extract of hyoscyamus), 
doset^v-x (0.3-0.6). 

Tinctura Hyoscyami [tincture of hyoscyamus), dosef3ss-j (2.0- 
4.0). 

HYOSCYAMlNiE Sulphas [hyoscyamine sulphate), dose gr. ^l^- 



MYDRIATIC ANODYNES-COCA. 113 

t*b (0.0006-0.0013) to begin with ; much larger doses may be given 
with impunity. 

Hyoscyaminje Hydrobromas [hyoscy amine hydrobromate), 
dose gr. y^Wo (0.0006-0.0013). 

Hyoscin^e Hydrobromas [hyoscine hydrobromate), dose gr. 
t%tj-£u (0.0006-0.0008) ; if given hypodermically, dose gr. T io _ T&u 
(0.0001-0.00064) to begin with, but much larger doses may be used. 

DUBOISIA. 

What is duboisia ? 

Duboisia (not official) is the leaves of D. myoporoides (Nat. Ord. 
Solanacese), a shrub of Australia. It contains an alkaloid, called 
duboisine, which is isomeric with atropine. Locally applied to the 
conjunctival sac it paralyzes accommodation and dilates the pupil 
more rapidly but for a shorter time than does atropine, and is less 
irritating. Given internally it dilates the pupil, stimulates the 
respiratory centre, and depresses the inhibitory cardiac ganglia, thus 
causing increase in frequency both of the respiration and cardiac 
action. It is used as a substitute for atropine in ophthalmic practice. 

COCA. 

What is coca ? 

Coca is the leaves of Erythroxylon Coca {Nat. Ord. Lineae), a 
shrub of Peru. - 

What does it contain ? 

It contains an alkaloid called cocaine combined with cocatannic 
acid. 

What are the physiological effects of erythroxylon ? 

Coca is a cerebral stimulant, producing a sense of calm and well- 
being, followed, if the dose is large, by a pleasant delirium. It 
lessens the sense of fatigue and of hunger, but does not take the 
place of food. Small doses appear to slow, while large quicken the 
pulse and cause an elevation of temperature. It diminishes the 
amount of urea excreted. Large doses cause, also, muscular weak- 
ness, drowsiness, and finally deep sleep. When taken in large doses 
habitually it causes disordered digestion, enfeeblement of the in- 
tellectual powers, emaciation, ascites, and death from marasmus. 
8 



314 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Cocaine produces similar effects. It is a cerebral stimulant, caus- 
ing delirium in large doses followed by epileptiform convulsions and 
coma if the dose has been excessive. It first stimulates, then de- 
presses the reflex spinal centres. Toxic doses depress and finally 
paralyze the nerves, these effects being more marked on the nerves 
of sensation. The effect on the circulation is disputed, but in small 
doses it increases the strength and frequency of the cardiac contrac- 
tions. It acts as a powerful stimulant upon the respiratory centre, 
but in large doses paralyzes it, the heart continuing to beat after the 
breathing has stopped. Injected hypodermically into the superficial 
tissues it causes local anaesthesia ; if a deep injection is given a slight 
general lessening of sensibility, dilated pupils, a slight rise in tem- 
perature with strong cardiac contractions result. 

Locally applied it causes marked anaesthesia of the surface with 
which it comes in contact, with some diminution of sensibility of 
the deeper structures. There is at first local pallor from contraction 
of vessels, followed by redness. Applied to the conjunctiva it 
dilates the pupil (which may, however, be contracted by eserine) 
transiently, lessens without entirely suspending the power of accom- 
modation, and lowers ocular tension. 

In toxic doses cocaine causes symptoms varying much in different 
persons. The most common symptoms are stimulation of the mental 
faculties ; loquacity ; incoherence ; depression of temperature accom- 
panied by profuse sweating; shallow, irregular respiration; feeble 
pulse; dilated pupils and disturbed vision; nausea and collapse. 
Sometimes there is intellectual torpor with tonic or clonic convul- 
sions. Sometimes the mental excitement is almost maniacal. 

Respiratory disturbances are always marked, in severe cases being 
of the Cheyne-Stokes type, and the sufferer may die from respira- 
tory paralysis. 

Individual susceptibility to the drug varies greatly, and even 
persons who have used it before without inconvenience may experi- 
ence a toxic effect from a dose of the same size as that which they 
had before taken. Even weak solutions applied to a mucous 
membrane occasionally produce alarming symptoms. 

The treatment of poisoning by cocaine consists in inhalations of 
amyl nitrite and chloroform ; ammonia should be given internally, 
and artificial respiration resorted to and continued for a long time. 



MYDRIATIC ANODYNES— COCA. 115 

Opium, or morphine, and chloral may be used if convulsions 
occur. 

What are the medicinal uses of coca and its alkaloid? 

Coca is not much employed in medicine. It may be given as a 
stomachic tonic in wasting diseases, as in phthisis. 

Cocaine is principally used as a local anaesthetic (2 to 10 per cent, 
solution), in operations on the various mucous membranes, particu- 
larly those of the eye, nose, mouth, pharynx and larynx, but also to 
those of the vagina, rectum and urethra. Injected into the super- 
ficial tissues it diminishes sensation sufficiently to allow of the per- 
formance of many operations in minor surgery, particularly if its 
diffusion is prevented by compressing the circulation of the part. 
In ophthalmology it is useful both for this purpose and from its 
rapid and transient mydriatic effect. 

To relieve pain and contract the blood vessels in the early stages of 
acute catarrhal inflammations, as coryza, hay fever, laryngitis and 
bronchitis ; to deaden sensation and thus lessen reflex cough in per- 
tussis, influenza, advanced phthisis and chronic laryngitis, it may be 
used in spray, or directly applied to the part by a brush. It has 
also been used as a hemostatic, applied to the mucous membranes, 
sspecially to the nasal mucous membrane, previous to an operation. 
It is highly recommended to allay the burning and itching of rhus 
poisoning. Internally it has been employed in gastrodynia, ner- 
vous dyspepsia, and to check reflex vomiting, as that of pregnancy 
or of sea-sickness (by the mouth or injected into the epigastric 
region), as a cardiac tonic in low fevers, and as a substitute for mor- 
phine in persons accustomed to the habitual use of the latter alka- 
loid. When used for this purpose the cocaine habit is apt to be 
formed, but can apparently be broken off suddenly without danger 
to the patient. 

What are the preparations and doses of coca ? 

Extractum Coo® Fluidum {fluid extract oferythroxylon), dose 
f3ss-ij (2.0-8.0). 

Cocaine Hydrochloras (cocaine hydrochlorate), dose gr. £-J 
(0.016-0.06). 



116 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 
ANTIPYRINE. 

Is antipyrine a mydriatic anodyne ? 

Antipyrine and other members of the antipyretic group are 
anodynes of considerable power, as has already been stated, and in 
large doses dilate the pupil, but are not used as mydriatics. 

ORDER III. — Anaesthetics. 
What are anaesthetics ? 

This name is applied to a group of medicines, the vapor of which 
when inhaled causes a temporary loss of sensibility to painful im- 
pressions {analgesia), with diminution and finally abolition of general 
sensation and reflex action, and lastly, complete loss of conscious- 



Name the agents of this group. 

Ether, chloroform, nitrous oxide, methylene bichloride, ethyl 
bromide and bromoform. 

AETHER— ETHER. 

What is ether? 

Ether is ethyl oxide, obtained by the distillation of alcohol with 
sulphuric acid. It is a colorless liquid, with a strong, disagreeable 
odor, and a hot, burning taste, and evaporates rapidly at ordinary 
temperatures. Its vapor is heavy — more than two and a half times 
as heavy as the atmosphere — and is very inflammable. 

What are its physiological effects ? 

When applied locally ether produces a feeling of coldness by its 
rapid evaporation, thus obtunding the sensibility of the part, and if 
the application be continued the part may be entirely frozen. 

When the vapor of ether is inhaled a sense of burning is experi- 
enced in the throat, followed by a feeling of suffocation and an irri- 
tative cough ; then comes a stage of stimulation, during which the 
action of the higher nerve centres is more or less interfered with, 
there is a feeling of lightness in the head and buzzing in the ears, 
and the circulation is quickened ; this passes into the narcotic stage, 
the patient becoming delirious and laughing, weeping, moaning, 
talking, singing or fighting. The face is suffused, the eyeballs in- 
jected and often protruding, the veins turgid, sensibility is dimin- 



ANESTHETICS— ETHER. 117 

ished, and tonic contractions of the muscles are often present. If 
the inhalation is continued the stage of anaesthesia soon supervenes, 
in which the functions of the spinal cord are influenced ; thus, there 
is not only complete insensibility, but also entire abolition of the 
reflexes. This stage may be continued indefinitely by care Pally 
regulating the inhalation. If, however, too much be given, the 
stage of paralysis ensues, in which the reflex centres of the medulla 
oblongata are paralyzed and the respiration and circulation cease. 
Stertorous respiration, from paralysis of the muscles of the palate, is 
the first indication of the approach of this stage. 

During the inhalation of ether the pupils at first contract slightly, 
afterward slightly dilate, but always respond to light. Sudden, wide 
dilatation is a sign of danger. 

The pulse is increased in frequency during the early stages of 
ether inhalation, afterward returning gradually to about the normal. 
The arterial pressure is increased, due principally to contraction of 
the peripheral capillary vessels and to the increased power of the 
cardiac beat. During the stage of paralysis the pressure falls when 
respiratory failure begins. 

In the first stage the respiration is increased both in frequency 
and depth, becoming much more shallow in the second stage, but 
again becoming deep and even stertorous in the third stage, and 
finally ceasing if the etherization be continued into the fourth stage 
from paralysis of the respiratory centre, the heart continuing to 
pulsate after the arrest of the respiratory movement. 

The after-effects are headache, vomiting, and a taste of ether in 
the mouth. Some hours elapse after profound anaesthesia before 
the patient fully regains the use of his mental faculties. 

Taken internally ether increases the secretions and is a cerebral 
and cardiac stimulant, being similar in its action to alcohol. 

It is rapidly eliminated by the lungs. 

What are the therapeutical uses of ether ? 

1. As an anaesthetic, ether is employed by inhalation for the pre- 
vention of pain during surgical operations and examinations, and 
during the passage of renal or biliary calculi. For these purposes the 
inhalation should be carried to the third stage — that of complete 
anaesthesia. To alleviate suffering during labor ether is often ad- 



118 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

ministered, but here it should only be inhaled during the pains, and 
the stage of complete anaesthesia is rarely required, unless some 
obstetric manipulations, as version, the application of the forceps, 
or craniotomy is necessary, or when it is desirable to prevent the 
patient from "bearing down," either from fear of laceration of the 
soft parts, or of the strain on the circulation in cardiac disease, or 
where thorough relaxation of a rigid cervix uteri is desired. 2. As 
a reflex depressant it is inhaled in various forms of convulsions during 
the paroxysms, and to promote the reduction of a hernia, or aid in 
diagnostic manipulations by relaxing tensely contracted muscles. In 
persistent hiccough it is sometimes successful when given internally, 
or may be used by inhalation to check the paroxysm. 3. As a car- 
diac stimulant it may be given hypodermically or by the mouth in 
cases of syncope or threatened cardiac failure. 4. It is sometimes 
used as a tceniackle ; and, 5. it has sometimes proved useful as an 
anodyne in neuralgia (injected in the vicinity of the nerve), and in 
nervous headache (given internally). 6. Locally it is employed to 
relieve pain in neuralgia, myalgia, muscular rheumatism and before 
the performance of minor surgical operations. 

What cautions should be observed in administering ether ? 

As ether is highly inflammable, it should not be administered by 
inhalation at night near a candle or gas light, nor near an open fire 
or very hot stove. If a light is in the room it should be placed as 
high as possible above the patient, as the vapor of ether sinks toward 
the floor. Ether is contraindicated in advanced pulmonary disease, 
and should be cautiously administered, if at all, in cases of cerebral 
tumors, grave renal disease and excessive exhaustion of the nerve 
centres. 

In cardiac diseases it is the safest anaesthetic and may be cau- 
tiously employed. 

How should alarming symptoms be treated ? 

(1) Stop the inhalation and lower the head ; (2) dash cold water 
on the face and chest and allow the patient plenty of fresh air; (3) 
use artificial respiration, make rhythmic tractions of the tongue at 
the rate of about 20 per minute, give atropine, strychnine, or nitro- 
glycerin hypodermically ; and (4) apply the faradaic current to the 
thoracic muscles. 



ANESTHETICS— CHLOROFORM. 119 

What are the official preparations of ether and how are they 
administered ? 

iETHER [ether— aether fort io r, U. S. P. 1880) contains about 96 per 
cent, by weight of absolute ether or ethyl oxide in alcohol and water ; 
dose n\, v -f3j (0.31-3.70). 

Spiritus iETHERis [spirit of ether-) contains 32.5 per cent, of 
ether in alcohol; dose irUv-f'Sj (0.92-3.70). 

When ether is administered by inhalation the patient should be, 
if possible, in the recumbent position, and, the nose and throat 
having been sprayed with a 10 per cent, solution of cocaine (Rosen- 
berg of Berlin), f^ss (15.0) may be poured on a napkin or sponge 
placed in a cone of stiff paper, which is then applied to the patient's 
mouth and nose, and kept there continuously, only removing it 
momentarily from time in time to add more ether, until the desired 
effect is produced. 

The anaesthetizer should pay the strictest attention to the condi- 
tion of his patient, watching closely the effect on the respiration 
and on the circulation as shown by the pulse and by the color of the 
skin or conjunctival mucous membrane. 

Ether inhalations are better administered on an empty stomach, 
as the after-effects, especially the tendency to vomiting, are thus 
lessened. 

Spraying the nose and throat with cocaine, as mentioned above, is 
said to increase the safety of the patient during the anaesthesia, 
and certainly prevents the coughing, gagging, and vomiting which 
otherwise usually accompany the action of the anaesthetic, and 
lessens the vomiting, headache, and persistent taste of ether which 
so often follow its use. 



CHLOROFORMTTM — CHLOROFORM. 

What is chloroform ? 

Chloroform is methenyl chloride or formyl terchloride, and is ob- 
tained by distilling alcohol with chlorinated lime and slaked lime. 

It is a limpid, colorless liquid, having a pleasant ethereal odor 
and an acrid, sweetish taste. 

It is soluble in alcohol and the oils, but is not very soluble in 
water. 



120 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are its physiological effects ? 

Applied locally it is to some extent anaesthetic ; if evaporation be 
prevented it is an irritant and even a painful vesicant. It assists 
the absorption of organic alkaloids by the skin, which otherwise 
wonld not penetrate the epidermis. When the vapor of chloroform 
is inhaled anaesthesia and unconsciousness rapidly result. 

The stage of stimulation is not as well marked as in the case of 
ether inhalation ; the narcotic stage is usually short in duration and 
the struggles of the patient are, as a rule, not violent. The pulse is 
quickened and apparently strengthened until the stage of anaesthesia, 
when with the abolition of consciousness and sensation and muscular 
relaxation it diminishes slightly in frequency and is more or less 
weak. The stage of paralysis is one of imminent danger. In addi- 
tion to the symptoms of the anaesthetic stage, there is stertorous 
breathing, entire abolition of the reflexes, with a weak and rapid 
pulse, and finally death, usually from cardiac paralysis* When swalr 
lowed in small doses it stimulates the secretions and increases peri- 
stalsis. In large amounts it is an irritant, causing gastro-enteritis, 
and after its absorption producing anaesthesia and coma. It is elimi- 
nated by the lungs and kidneys. 

How do the physiological actions of ether and chloroform 
compare ? 

Ether is the safer anaesthetic ; chloroform the more rapid, more 
transient in its effects, which are produced by smaller amounts, 
pleasanter, less irritating, and with less disagreeable after-effects. It 
does not cause so much vomiting, and its vapor is not inflammable. 
Death from ether (rare) is usually the result of respiratory paralysis 
and is gradual, while death from chloroform (much more frequent) 
is usually sudden, and is due to cardiac failure. 

What are the therapeutical uses of chloroform ? 

It has been used as an anaesthetic by inhalation in the same range 
of cases in which ether is given, but its employment for this pur- 

* The Hyderabad commission concluded, from their very elaborate experi- 
ments upon dogs, that death always occurs from respiratory paralysis, a con- 
clusion which at present is not in accord with clinical observation. The 
author has therefore adhered to the older view as to the mode of death under 
chloroform. 



ANESTHETICS— CHLOROFORM. 1 2 1 

pose is now very generally limited to diseases like puerperal eclamp- 
sia, in which it is necessary rapidly to produce anaesthesia and de- 
press reflex action. In obstetric practice it is largely used, but even 
here ether is safer. Administered internally it has proved service- 
able in cholera, protracted diarrhoea, and various forms of colic. It 
has also been used as a tceniacide. Given before the expected chill 
of malarial fevers it frequently aborts the paroxysm. Deep injec- 
tions in the vicinity of the affected nerve sometimes afford relief in 
obstinate neuralgia. Locally as an anodyne it is employed in the 
form of liniment in muscular pains and in neuralgic affections. Its 
contraindications as an anaesthetic are identical with those of ether, 
and in addition it should never be administered when any disease of 
the circulatory system exists or if the heart is feeble from any cause 
whatsoever. 

How should the occurrence of dangerous symptoms be met ? 

Stop the inhalations ; invert the patient ; artificial respiration ; fara- 
dization ; and atropine, strychnine, or nitroglycerin hypodermically. 
If it has been administered internally, treat the case as one of 
irritant or narcotic poisoning. 

What are the official preparations, and how may they be 
administered ? 

Chloroformum {chloroform), dose WLxv-fSj (1.0-4.0) in emulsion. 
As an inhalation, 20 drops of chloroform may be poured on a folded 
napkin and placed cautiously over the nose and mouth in such a 
manner that the vapor is freely diluted with atmospheric air 
Not more than 3? per cent, of chloroform should be contained in the 
air inspired. 

Aqua Chloroformi (chloroform ivater), dose f3j-jv (4.0- 
15.0). 

Spiritus Chloroformi [spirit of chloroform), dose f3ss-ij 
(2.0-8.0). 

Emulsum Chloroformi (emulsion of chloroform), dose f^j-ij 
(4.0-8.0). 

Linimentum Chloroformi [liniment of chloroform) contains 
chloroform 30 per cent, in soap liniment. 



122 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
NITROUS OXIDE. 

What is nitrous oxide ? 

Nitrous oxide (not official) or nitrogen monoxide is a colorless, 
almost odorless gas, made by the action of heat on ammonium 
nitrate. 

What are its physiological actions ? 

When nitrous oxide is inhaled in from one to three minutes com- 
plete anaesthesia occurs with loss of consciousness, often preceded by 
a stage of excitement ; the face is livid and the patient presents the 
appearance of asphyxia. The anaesthesia is probably due to diminu- 
tion in the relative amount of oxygen in the blood. When the 
inhalation is discontinued, consciousness and sensation speedily 
return, and as a rule no after-effects are manifested. When death 
results it is generally due to asphyxia. 

What are the therapeutics and the mode of administration 
of nitrous oxide ? 

As an anaesthetic in minor surgical operations of short dura- 
tion, as the extraction of teeth or the opening of abscesses, it 
is advantageously employed, but when the operation necessitates 
the maintenance of anaesthesia for some time, ether is a safer 
agent. 

It is best administered from an india-rubber bag, connected with 
an iron reservoir, containing at least eight gallons, furnished with 
a mouth-piece having two valves, so that the expired air may not 
pass back into the bag. 

METHYLENE BICHLORIDE: ETHYL BROMIDE: BROMOFORM. 

What are these substances ? 

Methylene bichloride (not official) is a neutral, colorless liquid, 
resembling chloroform in odor. Its vapor is inflammable. When 
inhaled it rapidly produces anaesthesia and unconsciousness, and 
these effects as rapidly disappear when the inhalation is discon- 
tinued. Death is due to cardiac paralysis. It is not much employed 
in this country. 

Ethyl bromide (not official) is a colorless, neutral liquid, having 
an ethereal odor and a disagreeable, sweetish taste. When inhaled 



LOCAL ANAESTHETICS. 123 

it is anaesthetic, acting on the heart like chloroform, and seems to 
be fully as dangerous. 

Bromoform (not official) is a heavy liquid with an agreeable taste 
and smell. Its effects resemble chloroform, but are slower. It is 
not much used as an anaesthetic. As an antispasmodic it has been 
used in pertussis in doses of gtt. ij-v (0.12-0.3) t. i. d. 

LOCAL ANESTHETICS. 

What are local anaesthetics ? 

They are remedies which produce an anaesthetic effect limited to 
the particular part to which they are applied. 

What are the indications for their employment, and what are 
the objections to their use? 

They are employed whenever it is necessary to obtund the pain 
in a part, either caused by disease or induced by a surgical operation, 
and when it is not necessary for any reason that the patient should 
lose consciousness. 

They are generally made use of prior to minor surgical operations 
for the avoidance of pain, although they have also been employed 
for the same purpose before major operations, as amputations. 

In such cases, however, it is often advantageous to have the 
patient unconscious, as the knowledge of what is being done, even 
in the absence of pain, may prove injurious by causing nervous per- 
turbation or by allowing the patient to interfere with the operator. 

They are objectionable in some cases on account of the anaemia 
which they produce, as during the reaction the resulting hyperaemia 
may be sufficiently intense to cause hemorrhage, or occasionally inter- 
fere with the healing process. 
How is local anaesthesia produced ? 

Either by freezing the part which it is desired to anaesthetize, or 
by the application to, or injection into it of an anaesthetic drug. 
How may a part be frozen for such a purpose, and what are the 
agents employed ? 

The part may be frozen by the direct application for a few 
minutes of a freezing mixture such as powdered ice and salt, or by 
spraying it with a very volatile liquid, such as rhigolene, ether, or 
ethyl chloride. 



124 ESSENTIALS OP MATERIA MEDIC A AND THERAPEUTICS. 

What are these substances, and how are they used ? 

Rhigolene (not official) is a very volatile and inflammable liquid 
obtained in the distillation of petroleum, and is used in the ordinary 
hand-atomizer. 

Ether has already been spoken of as a local anaesthetic. 

Ethyl Chloride (not official), or hydrochloric ether, is a very 
volatile liquid, which is sold in glass bottles having a minute orifice 
against which a tightly fitting stopper, moved by a small lever, is 
kept constantly pressed by means of elastic bands. When it is 
desired to use it the lever is pressed down, the orifice of the bottle 
passed rapidly over the part to be anaesthetized at a short distance 
from it, and the heat of the hand volatilizing the liquid in the bottle, 
the part is soon frozen by the spray. 

These agents are used as local anaesthetics in all minor surgical 
operations, such as opening abscesses or felons, the extraction of 
ingrowing toenails, paracentesis thoracis or abdominis, and are 
sometimes used to numb the.pazM.of headache and neuralgia. 



What drugs are employed topically or by hypodermic injec- 
tion for this purpose ? 

Cocaine (vid. Mydriatic Anodynes) is used locally as has already 
been mentioned, applied to the conjunctival, to the nasal, and to 
other mucous membranes as a local anaesthetic. 

It is also used by injection into the skin for the same purpose. 
When this is desired the part is first sprayed with ethyl chloride, and 
as soon as sensibility is obtunded the needle of the hypodermic syringe 
is inserted and a few drops of the cocaine solution instilled just 
beneath the integument. By injecting the solution in front of the 
point of the needle, which is then pushed further into the anaesthet- 
ized area, and a few more drops inserted, it is possible gradually to 
anaesthetize quite a large surface. By casting a ligature around the 
part and thus preventing the cocaine from passing out by the blood 
current, this anaesthetic action may be prolonged. 

By this or similar means local anaesthesia has been maintained for 
periods considerably over an hour, during which operative procedures 
of some magnitude have been performed. It is probably better, 
however, to employ general anaesthesia for major surgery unless 



LOCAL ANAESTHETICS. 125 

there is some contraindication to its employment, and to restrict the 
anaesthetic use of cocaine to minor surgery. 

Eucaine (not official) has been highly recommended as a local 
anaesthetic. The hydrochloride is used, and occurs as brilliant color- 
less crystals, readily soluble in water (which is not the case with 
eucaine itself). 

It is much more stable than cocaine, uot even decomposing when 
kept in solution. Locally applied to mucous membranes in 2 to 5 
per cent, solutions it causes anaesthesia, but it neither dilates the 
pupil nor causes ischaemia, as does cocaine, when applied to the 
conjunctiva. In fact, it appears to favor hyperaemia and does not 
interfere with the pupil reflex. It is said to produce a primary 
reduction in the cardiac frequency when given internally. In 
animals after large doses there is general nervous excitement fol- 
lowed by paralysis, sometimes preceded by tonic and clonic convul- 
sions. The blood-pressure falls and finally death occurs from respira- 
tory failure. 

No toxic symptoms have been reported as occurring in the human 
subject. 

It has been used as a substitute for cocaine to produce local 
anaesthesia, and may be employed in solutions of the strength of 2 to 
5 per cent. It has also been injected subcutaneously in the same 
manner as cocaine prior to the opening of abscesses or the removal 
of small tumors. It is said that as much as gr. xxx (1.9) has 
been used subcutaneously for this purpose without ill effect. 

Menthol (official) is a " stearopten (having the character of a 
secondary alcohol), obtained from the official oil of peppermint (from 
Mentha piperita), or from Japanese or Chinese oil of peppermint 
(from Mentha arvensis" u and Mentha canadensis," Nat. Orel. 
Labiatae). It occurs in the form of colorless, acicular or prismatic 
crystals, having a strong and pure odor of peppermint, and a warm, 
aromatic taste, followed by a sensation of cold when air is drawn 
into the mouth, and being only slightly soluble in water, but freely 
so in alcohol, ether, and chloroform. Menthol is a superficial, local 
anaesthetic. Given internally to animals in sufficient doses it 
depresses both the sensory and motor nerves, lowers the temper- 
ature, and depresses the respiration, which becomes slow and 
shallow. 



126 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

It is chiefly used as a local anaesthetic painted or sprayed on the 
part in ethereal or alcoholic solutions varying in strength from 10 
to 50 per cent. , in cases of neuralgia, toothache, and other superficial 
pains. The author has seen the burning pains which often follow 
herpes zoster quickly relieved and often permanently cured by a 
few applications of a 50 per cent, alcoholic solution. Urticaria and 
senile pruritus may be temporarily relieved by the application of a 
10 per cent, solution in albolene. It is also used with lanolin as an 
ointment, and has been used as an antiphlogistic remedy in super- 
ficial inflammations of the skin and mucous membranes. 

Guaiacol (not official), which has been considered among the 
antipyretics (q. v.), is also used as a local anaesthetic in neuralgice, 
especially in sciatica, and in rheumatic pains. 

Various other remedies, among which may be mentioned Tincture 
of Aconite {via 1 . Cardiac Sedatives), have been used locally in neuralgia 
for their local anaesthetic effect. 

ORDER IV. — Antispasmodics. 

What are antispasmodics ? 

Antisjxismodics are remedies which prevent or allay spasmodic 
action of voluntary or involuntary muscles by increasing the inhibit- 
ing power of the higher over the lower nerve centres. 

Name the antispasmodics. 

Musk, valerian, the valerianates, asafcetida, camphor, ethereal oil, 
and Hoffman's anodyne, cypripedium, and Scutellaria. 

MOSCHUS— MUSK. 

What is musk? 

Musk is the dried secretion from the preputial follicles of Moschus 
moschiferus, or musk deer. 
What are its effects and uses ? 

Musk is a mild cerebral stimulant and antispasmodic, slightly 
increasing the cardiac frequency. In cases of nervous exhaustion, 
however, it acts more powerfully, and when a pure article can be 
obtained no better nervous stimulant can be employed in the later 
stages of typhoid fever with great depression of vital forces, and 
in typhoid pneumonia. It is also of use in hysteria, hiccough, and 
chorea. 



ANTISPASMODICS— AS AFETIDA. 127 

What are the preparations of musk ? 

Moschus (musk) is very expensive and is often adulterated, and 
imitations are not infrequently substituted for the genuine article ; 
dose gr. x-xv (0.65-1.0) in capsule or emulsion. It is often given 
per rectum. 

Tinctura Moschi [tincture of mush), dose £3j-ij (4.0-8.0). 

VALERIANA — VALERIAN. 

What is valerian, and what does it contain ? 

Valerian is the rhizome and roots of V. officinalis or wild valerian 
(Nat. Orel. Valerianeae). It contains a volatile oil and a colorless 
volatile acid (valerianic). 

What are the effects and uses of valerian ? 

Large doses of valerian may cause nausea, vomiting, and some- 
times colicky pains. It slightly stimulates the brain and circulation, 
and increases the secretions of the skin and kidneys. Its effects are 
more decided in nervous excitement due to depression of the cerebral 
functions, as in hysteria or " nervousness," and in hypochondriasis. 
It has also been used as a cerebral stimulant in the delirium of low 
fevers and in delirium tremens. 

What are the preparations and doses of valerian? 

Extractum Valerianae Fluidum (fluid extract of valerian), 
dose f3j (4.0). 

Tinctura Valerianae (tincture of vederian), dose f3.j (4.0). 

Tinctura Valerianae Ammoniata (ammoniated tincture of 
valerian), dose f3j-ij (4.0-8.0). 

Ammonii Valerianas (ammonium valerianate) is much used in 
hysteria, neuralgia, and nervous headache ; dose gr. ij-x (0.13-0.65) 
in capsules or elixir. 

Iron valerianate and quinine valerianate have already been con- 
sidered ; zinc valerianate will be noticed under the zinc preparations. 

ASAFCETIDA — ASAFETIDA. 

What is asafetida, and of what is it composed ? 

Asafetida is a gunk-resin obtained from the root of Ferula foetida 
( Nat. Ord. Umbelliferae), a native of Afghanistan. It is composed 
of a gum-resin united to a volatile oil. 



128 ESSENTIALS OF MATEIUA MEDIC A AND THERAPEUTICS. 

What are its effects and uses? 

It is a gastric stimulant and carminative, and produces a sense of 
exhilaration. It increases the mucous secretions and peristalsis, and 
in large doses quickens the pulse and respiration. Very large doses 
may cause nausea and vomiting. 

It is used as an antispasmodic in hysteria and nervous exhaustion ; 
as a carminative in tympanites (by the rectum); as a stomachic 
tonic in dyspepsia with flatulent colic, and as an expectorant in 
chronic bronchitis and in whooping-cough, where it also acts as an 
antispasmodic. 

What are its preparations and doses ? 

Emulsum Asafcetid^e (emulsion of asafetida — lac asfoetidce), 
dose fgss-j (15.0-31.0), or as an enema f^ij-iv (62.0-124.0). 

Piluue Asafcetid^e (pills of asafetida), each pill containing 
gr. iij (0.2) of asafetida; dose No. ij-iv. 

Tinctura Asafcetid^e (tincture of asafetida) contains 20 per 
cent, of asafetida; dose f3ss-j (2.0-4.0). 

Pilule Aloes et Asaf(Etid^e (pills of aloes and asafetida), 
each pill contains of aloes, asafetida and soap gr. j£ (0.09) each. 

CAMPHORA— CAMPHOR. 

What is camphor? 

Camphor is a stearopten, derived from Cinnamomum Camphora, 
or camphor laurel {Nat. Ord. Laurineae), an evergreen tree of 
China and Japan. It is obtained by boiling chips of the tree in 
water and skimming off the camphor as it rises to the surface. This 
crude camphor is afterward refined by sublimation with quicklime. 

What are the physiological effects of camphor ? 

Locally camphor is an irritant. Internally in moderate doses it is 
to some extent an anodyne and a cerebral exhilarant, sometimes 
quickening the pulse and raising arterial tension, and occasionally 
proving aphrodisiac. In large doses (gr. xx (0.13)) it depresses the 
circulation, and produces lassitude and diaphoresis. It is also 
anaphrodisiac. In toxic doses (3ss-j (2.0-4.0)) it causes faintness, 
vertigo, headache, delirium, violent epigastric pain, unconsciousness, 
and sometimes convulsions. No case is recorded to have proved 
fatal in an adult. 



ANTISPASMODICS — CAMPHOR. 1 29 

What are the medicinal uses of camphor ? 

It is employed as an antispasmodic in " nervousness, " nervous 
headaches, hysterical complaints, dysmenorrhoea, u after-pains," 
simple diarrhoea, and combined with other remedies in cholera. It 
is also used in low forms of fever, to quiet delirium and sustain the 
system. As an anaphrodisiac to quiet abnormal sexual excitement 
in chordee, nymphomania, and priapism. Externally it is employed 
as a liniment in myalgia, muscular rheumatism, and sprains. Dis- 
solved in oil of turpentine it forms an efficient liniment in mild 
bronchial affections. 



What are its preparations and their uses ? 

Camphora {camphor) : dose gr. j-x (0.06-0.65), or even gr. xx 
(1.3) given in emulsion, or in pill or capsule. Not much used in 
this form. 

Aqua Camphors {camphor-water) contains 1 part of camphor 
in 125 parts of the preparation ; dose f3ss-ij (15.0-60.0). It is used 
chiefly as a vehicle or where a mild antispasmodic is needed. 

Spiritus Camphors {spirit of camphor) contains 10 per cent, of 
camphor. It is used as an embrocation, and is also given internally 
where a stronger preparation than the water is desired ; dose ^Iv-foj 
(0.3-4.0). 

Linimentum Camphors (camphor-liniment) contains 20 per 
cent, of camphor in cottonseed oil. 

Ceratum Camphors (camphor-cerate) contains 1 per cent, of 
camphor-liniment, 

Linimentum Saponis (soap-liniment) is much used externally, 
either alone or combined with stronger liniments. 

Camphora Monobromata (monobromated camphor) ; dose gr. 
v-x (0.32-0.65) in gelatin-coated pill or capsule. It is useful as an 
antispasmodic in hysteria, and as an anaphrodisiac in chordee and 
priapism. 

Hopes Camphor Mixture (not official) consists of nitrous acid 
f3j (4.0); laudanum ffixij (0.74); camphor-water fsviij (240.0). 
Dose, f^ss (15.0) repeated as required. Much used in diarrhoea 
and dysentery. 
9 



130 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
OLEUM ^ETHEREUM— ETHEREAL OIL. 

What is ethereal oil ? 

Ethereal oil, or oil of wine, is made by distilling alcohol with an 
excess of sulphuric acid and diluting with an equal volume of ether, 
and is a nearly colorless volatile liquid. It is antispasmodic, and in 
small doses a cardiac and vaso-motor stimulant, while in large doses 
it paralyzes the cardiac muscle and the vaso-motor nerves. It is 
only used medicinally as 

SPIRITUS ^ETHERIS COMPOSITUS — COMPOUND SPIRIT OF ETHER. 

What is this substance ? 

Compound spirit of ether, or Hoffman s anodyne, is a solution of 
ethereal oil (2.5) in ether (32.5) and alcohol (65.0), and is a good 
antispasmodic, circulatory stimulant and carminative, and is useful 
in the class of diseases to which antispasmodics are applicable, espe- 
cially when a cardiac stimulant is required; dose f3j-ij (4.0-8.0) 
repeated, and best administered in iced water. 

CYPRIPEDIUM : SCUTELLARIA. 

What are these remedies ? 

Cypripedium is the rhizome and roots of C. pubescens and of C. 
parviflorum (Nat. Ord. Orchideae), indigenous plants, commonly 
called ladies' slipper and moccasin plant. Scutellaria is the herb 
S. laterifolia or skullcap (Nat. Ord. Labiatse), an indigenous herb. 
They possess mild antispasmodic properties, and have been used as 
substitutes for valerian. 

Extractum Cypripedii Fluidum (fluid extract of cypripedium), 
dose tt\,x-xx (0.6-1.2). 

Extractum Scutellariae Fluidum ( fluid extract of Scutellaria), 
dose f3j (4.0). 

ORDER V.— Excito-Motors. 

What are excito-motors ? 

Excito-motors are medicines which by stimulating the reflex 
centres of the spinal cord excite muscular action. 

Name the excito-motors. 

Nux vomica and its alkaloids ; rhus toxicodendron and picrotoxin. 



EXCITO-MOTORS — NUX VOMICA. 131 

NUX VOMICA. 

What is nux vomica ? 

Nux vomica is the seed of the Strychnos Nux-vomica or poison 
nut {Nat. Ord. Loganiaceae), a tree of India. 

What active principles does it contain ? 

It contains two alkaloids, strychnine and brucine, combined with 
igasuric acid, and according to some investigators, a third alkaloid, 
igasurine, has been discovered. 

How may the presence of these alkaloids be detected ? 

Strychnine may be detected by the addition of a crystal of po. 
tassium bichromate to a solution of the alkaloid in concentrated sul- 
phuric acid on a porcelain plate, when a deep, rich blue color passing 
through purple into red rapidly makes its appearance. 

The 'physiological test is the production of tetanic spasms in a 
small animal (preferably a frog) to whom a minute amount of the 
suspected substance has been administered. 

Brucine with concentrated nitric acid strikes a blood-red color, 
fading into yellow. 

What are the physiological effects of nux vomica? 

The effects of nux vomica are identical with those of its alkaloids. 
The action of brucine is similar to, but much weaker than, that of 
strychnine. 

In small closes it increases the appetite and digestion and the peri- 
staltic movements of the intestines. When continued for some time 
in small doses it is a cardiac and vaso-motor stimulant, and increases 
the sensibility of the sensory nerves and nerves of special sense, so 
that sight, hearing and touch are more acute, and also stimulates the 
respiratory centre. In large doses it causes malaise, restlessness, 
anxiety, muscular twitchings, and finally clonic convulsions. Strych- 
nine acts principally on the spinal cord, stimulating especially its 
reflex, but also its motor, vaso-motor and sensory functions. After 
large doses, the reflex functions are so exalted that the slightest im- 
pression conveyed by a sensory nerve produces general convulsions. 
It is eliminated unchanged in the urine. 

What are the symptoms and treatment of strychnine poi- 
soning ? 
Sudden shuddering, quickly followed by tetanic convulsions of all 



132 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

the voluntary muscles, accompanied with muscular pains, opisthoto- 
nos, the risus sardonicus (a ghastly grin), a pale face, becoming livid 
from embarrassed respiration. After a time the muscles relax and 
an interval of quiet occurs, to be succeeded again and again by con- 
vulsions, if a liberal dose has been taken and is not antagonized by 
antidotes, until the sufferer dies of asphyxia from fixation of the 
respiratory muscles during a paroxysm ; or the patient may die of 
paralysis and collapse during one of the intervals. The mind is clear 
to the end. 

It differs from tetanus in history, in clonic (not tonic) spasms, in 
the muscles of the jaw not being affected before other voluntary 
muscles. 

The treatment consists in (1) evacuating the contents of the 
stomach by emetics or the stomach-pump before the convulsive 
stage, or washing out the stomach under ether or chloroform if not 
seen until the convulsions have commenced ; (2) giving tannic acid 
as a chemical antidote and chloral (hypodermically) as an antagonist ; 
and (3) the frequent use of the catheter to prevent resorption of the 
poison from the bladder. 

What are the therapeutical uses of nux vomica and strych- 
nine? 

It is employed (1) as an excito-motor in all cases of paralysis due 
to depression of the spinal or other motor centres, as in diphtheritic, 
alcoholic, or lead paralyses, paraplegia,, infantile paralysis and 
hemiplegia after the subsidence of irritation. As it stimulates the 
nerve centres, it is contraindicated whenever inflammation or ex- 
citation of these centres is present ; hence, in paralyses due to the 
presence of blood-clots it may do great injury if too early exhibited. 
In constipation due to atony and relaxation of muscular fibres, or in 
diarrhoea, dysentery, impotence, or incontinence of urine from the 
same cause, it is very useful. (2) In amaurosis, especially when due 
to the abuse of tobacco or of alcohol, and in amblyopia from disease, 
strychnine pushed to the verge of tolerance is very efficacious. It is 
more useful before atrophy of the optic nerve fibres has occurred. 
(3) As a cardiac and respiratory stimulant in dyspnoea depending 
on chronic bronchitis, emphysema, phthisis, or due to cardiac disease, 
as fatty or dilated heart, it is of value, and is often combined or 
alternated with digitalis in the latter affection. (4) As a general 



EXCITO-MOTORS— RHUS TOXICODENDRON. 133 

tmic it is advantageously given in atonic dyspepsia, gastric catarrh, 
ancemia and chlorosis (combined with iron), as an adjunct to quinine 
in obstinate malarial fevers, in various neuralgice occurring in debil- 
itated subjects, and in convalescence from acute diseases (combined 
with iron and other tonics). Minute doses of nux vomica (tincture) 
will often arrest the vomiting of pregnancy. 

What are the official preparations and their doses ? 

Extractum Nucis Vomica {extract of mix vomica), dose gr. 
1-j (0.016-0.065) given in pill. It is frequently combined with 
purgatives to enhance their effect. 

Extractum Nucis Vomica Fluidum (fluid extract of nux 
vomica), dose ^Uj-x (0.12-0.61). 

Tinctura Nucis Vomicae {tincture of nux vomica), dose ^VJ-xx 
(0.06-1.2). Chiefly used as a bitter tonic. 

Strychnina {sti-ychnine), preferably given as — 

Strychnine Sulphas {strychnine sulphate), dose gr. ^-^o 
(0.002-0.003) internally, or gr. ^ (0. 001) , cautiously increased, if 
used hypodermically. As a cardiac tonic strychnine is often given 
in large doses, frequently repeated. It is not safe, however, to 
begin with a larger dose than gr. ^-~2^ (0.002-0.003). As a tonic, 
minute doses may be given in pill, alone or combined with other 
medicines. In nervous affections it should be given in solution, 
the dose being gradually increased until slight muscular twitchings 
are produced. 

Iron and strychnine citrate and syrup of iron, quinine and strych- 
nine phosphates have been noticed with the iron preparations. 

RHUS TOXICODENDRON. 

What is this substance ? 

It is the fresh leaves of the Rhus radicans, poison-oak or poison- 
ivy {Nat. Ord. Anacardieoe), which contains toxicodendric acid. 
Locally applied it produces in many persons a very distressing 
eczematous eruption attended with much inflammation and swell- 
ing of the skin. Some persons are so susceptible that these symp- 
toms occur if they are in the vicinity of the growing plant, even 
without coming in contact with it. 

The treatment consists in alkaline washes, lotions of lead or corro- 



134 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

sive sublimate (1 to 8000 or even weaker) or the application of car- 
bolic acid in glycerin. Internally it is a gastro-intestinal irritant, 
causing also drowsiness, stupor, delirium and convulsions. Its pre- 
cise use is not clear, but it has been given as a substitute for nux 
vomica in paralysis and in incontinence of urine. Dose gr. j-iij 
(0.06-0.19), perhaps, if given at all; best administered in the form 
of a tincture. 



PICROTOXINUM — PICROTOXIN. 

What is picrotoxin? 

Picrotoxin is a neutral principle prepared from the seeds of Ana- 
mirta paniculata {Nat Ord. Menispermaceae), a climbing shrub of 
India. Its action on the brain resembles that of belladonna, while 
it affects the spinal centres somewhat like nux vomica : thus, it 
causes nausea, vertigo, delirium, incoordination, muscular twitching, 
followed by epileptiform convulsions, alternating tonic and clonic 
spasms, coma and cardiac paralysis. It stimulates all the motor and 
inhibitory centres of the medulla, particularly the respiratory and 
vagus centres, and excites the motor and reflex spinal centres. It is 
at present chiefly used to check the night-sweats of phthisis, but has 
also been recommended as an excito-motor in functional paralysis and 
in paralysis or relaxation of the sphincters. It is said to be of ser- 
vice in chorea when given in full doses. Locally it is used as an 
ointment (gr. v-x to ^j (0.3-0.6 to 31.0)) in parasitic skin diseases 
and to destroy pediculi, but care should be used in applying it, as 
constitutional effects and even death have followed its employment 
externally. Dose gr. 2<j(nnj (0.0003-0.001). 

ORDER VI— Depresso-Motors. 

What are depresso-motors ? 

They are remedies which are used to depress the functions of the 
spinal cord, motor nerves or muscles, thus lessening motivity. 

Name the members of this group. 

Physostigma ; chloral ; the bromides ; the nitrites ; gelsemium ; 
prussic acid ; the cyanides ; oil of bitter almonds ; lobelia ; conium ; 
woorara, and tobacco. 



DEPRESSO-MOTORS — PHYSOSTIGMA. 1 35 

PHYSOSTIGMA. 

What is physostigma, and what active principles does it 
contain ? 

Physostigma, or Calabar bean, is the seed of P. venenosum (Nat 
Ord. Leguminosae), a plant found on the western coast of Africa. 
It contains an alkaloid called eserine or physostigmine, and it is 
claimed that a second alkaloid (atetanizing agent), called calabarine, 
has also been discovered, but this is probably a derivative alkaloid 
of eserine. 

What are the physiological effects of physostigma ? 

Calabar bean is a reflex depressant, causing also, in full doses, gid- 
diness, slow and often irregular pulse, great muscular weakness, 
nausea and sometimes vomiting, generally free purgation, and 
usually contraction of the pupils. When poisonous doses are taken, 
there are, in addition, muscular tremors and abolition of reflex 
action, slow pulse and respiration, myosis and motor paralysis, and 
death from respiratory failure. 

It depresses and finally paralyzes tne reflex and motor centres of 
the spinal cord, having but slight effect upon the nerves themselves. 
It slows the heart (by greatly lengthening the diastolic pause) and 
increases its power (acting either on the cardiac motor-ganglia or 
muscle). The blood pressure at first falls, but soon rises and 
remains high until death approaches. It stimulates intestinal peri- 
stalsis and increases the secretions of the part. On the eye its action 
is probably directly opposed to that of atropine, for no matter how 
used it contracts the pupil, probably by paralyzing the peripheral 
sympathetic nerve-fibres in the iris and at the same time stimulating 
the end organs of the 3d pair of nerves. It is probably eliminated 
**b^ the urine. 

How should poisoning by this drug be treated ? 

(1) Give emetics and cathartics, and use a catheter to prevent 
further absorption of poison; (2) use atropine hypodermically as 
a physiological antagonist, and (3) give other cardiac and respiratory 
stimulants as digitalis, ammonia, and alcohol. 

For what purpose is it employed medicinally ? 

As a deprcsso-motor it is used in tetanus, trismus neonatorum, 
ejnhpsy and chorea with some success. It has also been given as a 



136 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

physiological antagonist in strychnine poisoning, but is probably 
inferior to chloral for this purpose. 

From its influence over intestinal peristahis, it is advantageously 
used in habitual constipation, especially when associated with chronic 
intestinal dyspepsia and dry, hard stools. The alkaloid is used in 
ocular therapeutics, to prevent or overcome adhesions of the iris, 
lessen intra-ocular tension and contract the pupil. 

What are its preparations and doses ? 

Extractum Physostigmatts {extract of physostigma), dose gr. 
T V-i (0.005-0.03). 

Tinctura Physostigmatis {tincture of physostigma), dose tflv- 
xxx (0.3-2.0). 

Physostigmin^e Sulphas (physostigmine sulphate), a very 
deliquescent salt ; dose eV-rV (0.001-0.005). 

Physostigmine Salicylas {}-)hysostigmiuc salicylate), preferred 
to the sulphate because of its greater permanency ; dose gr. eVrV 
(0.001-0.005). 

Chloral and The Bromides have been discussed under the 
head of hypnotics {vid. pp. 95-99). 

THE NITRITES. 

What are the nitrites? 

The nitrites are salts formed by the union of nitrous acid* with 
a base. 

A myl nitris (amyl nitrite) is the only official organic nitrite (except 
the sweet spirits of nitre, which contains ethyl nitrite and will be 
considered elsewhere). It is a yellowish, oily, very volatile liquid, 
with a pleasant, fruity odor. Nitroglycerin (trinitrin, trininitro- 
glycerin or glonoin) is a colorless, oily liquid, without odor, soluble 
in ether and alcohol. It forms the basis of various explosives. 
It is really a trinitrate (not a nitrite) of glyceryl or .propenyl 
[C 3 H 5 (N0 3 )3]. Potassium and sodium nitrites are also used. 

What is the physiological action of the nitrites ? 

They cause vertigo, headache, excited cardiac action, great dilata- 

* See foot-note on p. 71. 



DEPRESSO-MOTORS— THE NTTRTTES. 137 

tion of the arterioles and capillaries (from paralysis of their muscular 
coats), and consequently greatly diminished blood pressure, slowed 
respiration, lowered temperature, and diminished reflexes. After 
toxic doses, the pupils dilate, the muscular system relaxes, the blood 
becomes darker (probably from the formation of methemoglobin), 
the respiration and circulation become slow and irregular, and finally 
death occurs from respiratory failure, sensation and consciousness 
being preserved to the last. They depress both the motor and reflex 
spinal centres without influencing either the sensory nerves or cen- 
tres. They first stimulate the heart, but soon depress and finally 
paralyze the cardiac muscle by direct action. The temperature is 
lowered, owing to lessened oxydation. The nitrites are all muscle 
poisons. They are eliminated by the urine, increasing greatly the 
amount of water and the uric acid and urea. The action of amyl 
nitrite is the most rapid, but most transient; nitroglycerin is the 
slowest, but its effects are more lasting, — the headache, however, 
which it causes, is very persistent, and often constitutes a great objec- 
tion to its use. It sometimes causes nausea and vomiting. 

What are the therapeutical uses of the nitrites ? 

The nitrites are used (1) as depresso-motors to relax spasm in 
angina pectoris, asthma, tetanus, puerperal and other forms of con- 
vulsions, strychnine poisoning, congestive and nervous dysmenorrhea, 
and in all cases of very high arterial tension from spasm of the 
arterioles ; thus, in renal asthma the inhalation of a few drops of 
amyl nitrite quickly relieves the spasm, and migraine with capillary 
spasm is frequently benefited by it. Given just before the expected 
chill of malarial fevers it will abort it, and sometimes avert the 
paroxysm. If amyl nitrite is inhaled when the ' ' aura epileptica ' 
is experienced, it will often prevent the epileptic attack. Nitro- 
glycerin has proved of value in chronic interstitial nephritis, lessening 
the albuminuria and relieving the arterial spasm. Obstinate hic- 
cough has been benefited by nitroglycerin. 

(2) As cardiac stimulants the nitrites are employed in syncope, 
cardiac dyspnoea, and in threatened cardiac failure during the ad- 
ministration of anaesthetics, especially chloroform. 

(3) They have also been found useful in the nausea and vomiting 
of sea-sickness and of pregnancy. 



138 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are the doses of the nitrites, and how are they admin- 
istered? 

Amyl Nitris (amyl nitrite), given internally or by inhalation- 
doseTTUj-v (0.1-0.3). 

Sodii Nitris (sodium nitrite), dose gr. ij-iij (0.1-0.2). 

Potassium nitrite is not official. It may be used in the same doses 
as the sodium salt. 

SPIRITUS GrLONOINI (spirit of glonoin — spirit of nitroglycerin) is 
a 1 per cent, alcoholic solution of nitroglycerin, the dose of which 
is n\,ss (0.03) cautiously increased. 

Triturates of nitroglycerin, each containing gr. y^y (0.0006), are 
also employed. 

Amyl nitrite is usually given by inhalation, but may be adminis- 
tered internally on sugar, or even hypodermically. The other pre- 
parations are given by the mouth. If a speedy action is required 
amyl nitrite should be used, and after the immediate danger is over, 
if it is desired to maintain the effect, the other nitrites or nitro^ 
glycerin may be given. 

GELSEMIUM. 

What is gelsemium, and what chemical principles does it 
contain ? 

Gelsemium is the rhizome and roots of Gr. sempervirens, the yel- 
low or Carolina jasmine (Nat. Ord. Loganiaceae), a climbing plant 
of the Southern States. It contains two alkaloids, gelsemine and 
gelseminine, combined with gelseminic acid, a volatile oil, resin, etc. 

What are its physiological effects ? 

Small doses produce languor, dizziness, and perhaps slight lower- 
ing of the pulse rate ; large doses diminish the force and frequency 
of the pulse and lower arterial pressure, depress respiration, cause 
frontal headache, and disordered, usually double vision ; toxic doses 
cause extreme muscular weakness, partial blindness, dilated pupil, 
often internal strabismus, ptosis, incoordination, the jaw drops, 
articulation is impaired, general sensibility is much diminished, 
respiration is slowed, the pulse is very feeble, the temperature de- 
clines, a profuse cold sweat breaks out, and death occurs from 
respiratory failure, preceded in animals by convulsions followed by 



DEPRESSO-MOTORS— GELSEMIUM. 1 39 

general paralysis. The mind remains clear until the end approaches. 
The paralyses of sensation and of motion appear to be of spinal 
origin, and the convulsions in animals have been attributed to 
excitation of the reflex spinal centres from gelseminic acid, which is 
supposed to be a tetanizing agent. The respiratory centre is de- 
pressed and finally paralyzed. The poison appears in toxic doses to 
depress the heart directly. It paralyzes the end-organs of the 
motor oculi, thus causing mydriasis with paralysis of accommodation 
and ptosis, and must also act on the 6th nerve, as the action of the 
external rectus muscle is much enfeebled. 

What are its therapeutic uses ? 

It has been used as a motor depressant in asthma, laryngismus 
stridulus, pertussis, and nervous cough and tic douloureux ; as a sen- 
sor-depressant in trigeminal neuralgia, especially when associated 
with spasm, and in various other neuralgic affections; as a calmative 
in mania (full doses) ; as a cardiac sedative in sthenic fevers and 
inflammations, and in ocular therapeutics. Its chief use is in neu- 
ralgia, especially of the 5th nerve. 

What are its preparations and their doses ? 

Extractum Gelsemu Fluidum {fluid extract of gelsemium), dose 
TTiv-x (0.3-0.6) (f3j (4.0) has proved fatal), repeated every 2 or 3 
hours until constitutional effects are produced. 

TlNCTURA G-ELSEMII {tincture of gelsemium), dose tt^v-xx (0.3- 
1.2). 

ACIDUM HYDROCYANICUM DILUTUM — DILUTED HYDROCYANIC ACID. 

What are the sources of hydrocyanic acid ? 

Hydrocyanic or prussic acid exists in bitter almonds, peach ker- 
nels and leaves, wild cherry, etc. , but is used in medicine only in a 
very diluted solution. The diluted acid is formed by the reaction of 
sulphuric acid and water upon potassium ferrocyanide or of hydro- 
3hloric acid on silver cyanide, and is a colorless, volatile liquid with 
an odor resembling that of bitter almonds. It contains 2 per cent, 
of the absolute acid. 

How may the presence of prussic acid be detected? 

1. The addition of a solution of silver nitrate produces a white 



140 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

precipitate entirely soluble in boiling concentrated nitric acid. 2. 
The addition of a small amount of a mixed solution of ferrous and 
ferric sulphate, and afterward a little liquor potassse, gives a dirty, 
greenish-blue precipitate, which changes to Prussian blue when 
slightly acidulated with hydrochloric acid. 

What are its physiological effects ? 

Locally applied it passes through the cuticle and paralyzes the 
end-organs of the sensitive nerves beneath. When its vapor is in- 
haled or when the acid is taken in sufficient doses, it kills almost 
immediately, from arrest of circulation. If the toxic dose has not 
been large enough to arrest the circulation instantly, dyspnoea and 
depression of the heart occur, followed by dilated pupils, convulsions 
and unconsciousness, and death from asphyxia and collapse. 

The convulsions are of cerebral origin. Prussic acid is a direct 
nerve and muscle poison. In large doses it causes diastolic arrest by 
direct action either on the heart muscle or its contained ganglia : in 
small doses it slows the heart by stimulation of the inhibitory cen- 
tres. It stimulates at first the vaso-motor system and for a short 
time raises arterial tension, but it soon depresses and finally paralyzes 
the vaso-motor apparatus and the blood pressure falls. The 
venous blood at first becomes of an arterial hue but soon darkens, 
and after death even the arterial blood has lost its bright color. 
The cause is not well understood. Asphyxia is due to paralysis 
of the respiratory centre. It is rapidly eliminated by the lungs and 
kidneys. 

How should poisoning by prussic acid be treated ? 

Evacuate, if possible, the contents of the stomach ; give atropine 
hypodermically as a respiratory stimulant ; give ammonia freely by 
inhalation, by the mouth and by intra- venous injection ; practice arti- 
ficial respiration assiduously and use alternate hot and cold douches. 
Death usually results so rapidly that nothing is of much service. 

What are the medicinal uses of diluted hydrocyanic acid ? 

It is used (1) as a depresso-motor and nerve sedative in various 
forms of cough, as that of phthisis, also in asthma and in whooping 
cough. In obstinate vomiting it is sometimes successful. In gastro- 
dynia and in enteralgia it has proved beneficial, probably by a local 



DEPRESSOMOTORS— OIL OF BITTER ALMOND. 141 

action on the nerves of the parts. When successful in these cases, 
it is so speedily. 

(2) Locally (f3j-iij to Oj (4.0-11.0 to 480.0)) it is used as an 
anodyne in neuralgia and in many cutaneous affections attended with 
pruritus. Great caution should be used when it is thus applied, 
as fatal results have attended its absorption through an abraded 
surface. 

How is it administered ? 

Acidum Hhdrocyanicum Diluttjm {diluted hydrocyanic acid), 
dose gtt. j-iij (0.06-0.18) diluted. 

THE CYANIDES. 

What are the effects, uses and doses of the cyanides ? 

Potassii Cyanidum {potassium cyanide). Locally it is an irri- 
tant. It may be absorbed through the skin, when the application is 
prolonged, and cause poisoning. When administered iniernaUy it 
reacts with the acids of the gastric juice and prussic acid is set free, 
consequently the systemic effects are identical with those of that 
acid, as a substitute for which it is used. Dose gr. tz~f (0.005- 
0.008). 

Argenti Cyandium (silver cyanide) is only used in medicine in 
making prussic acid. 

Mercury cyanide has been noticed among the mercurial prepa- 
rations. 

OLEUM AMYGDALvE AMABJE — OIL OP BITTER ALMOND. 

What are the effects, uses, and dose of this oil? 

Oil of bitter almond is a volatile oil obtained by distillation from 
the kernel of the fruit of Prunus Amygdalus (var. amara., Nat. 
Ord. Rosaeese). It contains benzoic aldehyd and hydrocyanic acid 
(due to the reaction of amygdalin with water, in the presence of 
an albuminous ferment called emidsin). Its effects and uses are 
the same as those of prussic acid. Dose ^ll- ss (0.015-0.03), in 
emulsion. 

Aqua Amygdalae Amar^e {bitter almond water) contains ^ of 
1 per cent, of the oil, and is used as a vehicle; dose f3j-iv (4.0- 
15.0). 

Spiritus Amygdala Amar^e {spirits of bitter almond— essence 



142 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

of hitter almond) contains 1 per cent, of the oil; dose ^Ij-xx 
(0.06-1.2). 

Syrupus Amygdalae [syrup of almonds), made from both sweet 
and bitter almonds, is used as a vehicle. 

Emulsum Amygdalae [almond emulsion — miUe of almonds), made 
from the sweet almonds alone, is also used as a vehicle. 



lobelia. 

What is lobelia, and what are its active ingredients ? 

Lobelia is the leaves and tops of L. inflata, or Indian tobacco 
(Nat. Ord. Lobeliaceae), an indigenous plant. It contains an 
alkaloid, lobeline ; also lobelic acid, fixed and volatile oils, etc. 

What are its effects and uses ? 

In large doses it causes nausea, violent vomiting with great de- 
pression, sometimes purging, feeble pulse, almost complete muscular 
relaxation, and, if a lethal dose has been taken, collapse, coma, some- 
times preceded by convulsions, and death from paralysis of the 
respiratory centre. 

Large doses appear to paralyze the motor nerves, the vaso-motor 
centre and the peripheral vagi. Its action has not been fully studied. 

The treatment of lobelia poisonin g consists in emetics, tannic acid, 
morphine, alcohol, ammonia and counter-irritation to the surface. 

It is used as a depresso-motor and expectorant in asthma and in 
acute bronchitis with spasmodic dyspnoea. In other spasmodic dis- 
eases it has been superseded by more reliable and less dangerous 
remedies. It is too depressing in its action to be used as an emetic. 

Locally, in infusion (£j to Oj (30.0 to 480.0)), it is highly recom- 
mended as an application to poison-oak eczema. 

What are the preparations of lobelia and their doses ? 

Extractum Lobelia Fluidum {fluid extract of lobelia), dose 
as an expectorant THj-v (0.06-0.3) ; as an emetic n^xv-xx (1.0-1.2). 

Tinctura Lobeline [tincture of lobelia), contains 20 per cent, of 
lobelia ; dose as an expectorant tt\,x-xx (0.6-1.2) ; as a motor-depres- 
sant in asthma f3j (4.0) repeated every £-1 hour until nausea is 
experienced. 



DEPRESSO-MOTORS— CONIUM. 143 

CONIUM. 

What is conium, and what active principles does it contain? 

Coniwn is the full-grown fruit of C. maculatum. or hemlock (J\ T at. 
Ord. Uinbelliferae), gathered while yet green and carefully dried. 
The active principle is conine, a volatile liquid alkaloid. It also 
contains conydrine, methyl-conine, and psendoconydrine. 

What are its physiological effects ? 

Full medicinal doses cause great muscular weakness, first felt in 
the lower extremities, difficulty in keeping the eyelids raised, and 
disordered vision from paralysis of accommodation. Sometimes the 
pupils dilate, and sometimes there is nausea and vomiting. After a 
poisonous amount has been taken, these symptoms are intensified, 
and difficulty of speech, delirium or coma, paralysis, and death from 
asphyxia, preceded by convulsions of cerebral origin, occur. Conium 
has little if any action on the cerebral hemispheres, and but little is 
known of its influence on the spinal cord. It paralyzes the periphe- 
ral ends of nerves, acting much more powerfully on the motor than 
on sensory fibres. The effects on the ocular apparatus are due to 
peripheral oculo-motor paralysis. The pulse is at first accelerated 
(paralysis of the vagi), but afterward slowed (depression of cardiac- 
motor nerves), and the blood pressure, which was primarily lowered, 
is raised when symptoms of asphyxia take place. It is eliminated 
by the urine. The treatment of poisoning consists in evacuating 
the contents of the stomach, giving tannic acid as an antidote, 
maintaining artificial respiration and administering, as antagonists, 
atropine, and strychnine or picrotoxin. 

What are the medicinal uses of conium ? 

Conium has been used as a depresso-motor in whooping-cough, 
paralysis agitans, chorea, blepharospasm, asthma and other spas- 
modic affections. It has been used as a calmative and relaxant in 
maniacal and hysterical excitement, and also in melancholia. As an 
anodyne it is employed internally and locally in cancer, and in neural- 
gia, especially sciatica. 

What are the preparations and doses of conium ? 
Extractum Conii [extract of conium), dose gr. j (0.06). 



144 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Extractum Conii Fluidum {fluid extract ofconium), dose ni j- v 
(0.06-0.3). 

As different samples of the drug vary much in the amount of 
conine contained, it is safer to begin with a small dose, to be gradually 
increased until some effect is obtained. 

WOORARA. 

What is woorara? 

Woorara (not official), called also woorali and curare, is an extract 
prepared by the South American Indians from Strychnos toxifera 
and other species of Strychnos (Nat. Ord. Loganiaceae), and is used 
by them as an arrow-poison. It contains an alkaloid called curarine. 

What are its effects and uses? 

It is eliminated so rapidly that usually when administered inter- 
nally no symptoms result. When it enters the system through a 
wound or by hypodermic injection it paralyzes the peripheral endings 
of the motor nerves, and if the dose be sufficiently large the vagus 
and the ends of the sensory nerves are also paralyzed. After a time 
the nerve trunks and the spinal cord are also affected. The volun- 
tary muscles are uninfluenced. Large amounts lower the blood pres- 
sure and finally depress the heart. Death results from paralysis of 
the motor respiratory nerves. Small doses increase all the secretions. 
It is eliminated chiefly by the urine. 

The treatment of ivoorara-poisoning consists in frequent catheteri- 
zation to prevent resorption, artificial respiration, and atropine and 
strychnine, hypoclermically as antagonists. They can scarcely be 
relied on. 

Woorara is used as a depresso-motor in tetanus and in hydrophobia, 
and has also been employed in epilepsy and in chorea. It is given in 
doses of gr. -^ (0.006), or its alkaloid, curarine, maybe used in doses 
of gr. 2^0-dro (0.0003-0.0006). 

tabacum— tobacco. 

What is tobacco, and what does it contain? 

Tobacco is the commercial, dried leaves of Nicotina Tabacum (Nat. 
Ord. Solanacese). It contains nicotine, a volatile liquid alkaloid; 
nicotianin (tobacco-camphor) and an empyreumatic oil. 






DEPRESSO-MOTORS — TOBACCO. 145 

What are its effects and uses ? 

To persons unaccustomed to its use, tobacco or nicotine is a de- 
pressant, nauseant and emetic, and causes dizziness and weakness. 
When a toxic dose is taken, purgation, diuresis, cramps or convul- 
sions, followed by great muscular weakness and, finally, paralysis, a 
rapid, feeble and compressible pulse, collapse and death from pa- 
ralysis of the respiratory muscles. 

It first stimulates the spinal centres (thus causing convulsions), 
but probably finally paralyzes them. It first excites and then 
abolishes the functions of the peripheral endings of motor nerves, 
the nerve trunks being afterward affected, but has no influence on 
voluntary muscles. The cardiac action is first depressed from some 
unexplained cause, afterward much increased, probably from paralysis 
of the peripheral inhibitory nerves, and the blood pressure, which 
at first falls, is afterward elevated. Nicotine contracts the pupil, 
whether applied locally or administered internally. 

Tobacco increases intestinal peristalsis, and is probably eliminated 
chiefly by the urine, which it greatly increases. 

The treatment of nicotine poisoning consists in emetics or washing 
out the stomach, tannic acid and strychnine with artificial respiration. 

Tobacco is not much used at present as a depresso-motor, but may 
be employed for this purpose in tetanus and in strychnine poisoning. 
In persons unaccustomed to its use, smoking a strong cigar may 
relieve an attack of spasmodic asthma. As a local anodyne, it has 
been used as a poultice to painful ulcers, as an ointment to inflamed 
hemorrhoids, and as a lotion to relieve pruritus. Great caution 
should be observed, as its local use has resulted in poisoning and 
death. There are no official preparations. Dose gr. j-iij (0.06-0.19), 
in infusion, which in poisoning by st^chnine or in tetanus must be 
frequently repeated until some results are obtained. 
10 



146 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

(B) ON THE ORGANS OF CIRCULATION. 

ORDER I. — Cardiac Stimulants. 
What are cardiac stimulants? 

They are medicines which are administered with a view of increas- 
ing the power of the heart or the force of the circulation. 

Mention the remedies of this order. 

Alcohol, ether, the ammonium preparations, amyl nitrite, nitro- 
glycerin, atropine, digitalis, caffeine, adonidine, strophanthus, spar- 
teine, strychnine, cimicifuga. 

ALCOHOL. 

What is alcohol ? 

Alcohol (ethjd hydrate) results from the fermentation of sub- 
stances containing grape sugar. It is a colorless, inflammable liquid, 
uniting in all proportions with water. Alcohol contains 94 per cent, 
by volume of absolute alcohol, which is 'not used in medicine. 

What are the physiological effects of alcohol ? 

Locally applied it is an astringent. It evaporates rapidly and 
produces a feeling of cold, but if evaporation is prevented it acts as 
an irritant. When its vapor is inhaled it causes anaesthesia, coma 
and death. Taken internally in small doses it increases appetite and 
digestion, temporarily increases the force and frequency of the cardiac 
systole, dilates the vessels, thus causing a sensation of warmth, and 
diminishes the amount of urea and of carbonic acid eliminated. The 
continued use of small doses disorders the digestion and the hepatic 
functions, produces gastric catarrh and hyperplasia of the connective 
tissues, resulting in sclerosis of different viscera, and tends to the 
production of fatty degeneration of the walls of the vessels and 
various organs. 

Large doses disorder digestion and cause the well-known alcoholic 
intoxication with muscular incoordination and weakness, hallucina- 
tions, lowered temperature, depression of the heart and reflexes, and 
stupor. 

After toxic doses death from respiratory or cardiac failure may 
rapidly result, preceded by insensibility, stertorous breathing and 
coma, and occasionally by convulsions. 

In small doses it stimulates the cardiac motor ganglia and the 



CARDIAC STIMULANTS — ALCOHOL. 147 

heart muscle, followed, if a large dose be taken, by depression and 
paralysis of the cardiac muscle. Large doses also paralyze the vaso- 
motor system and dilate the vessels. 

Small doses slightly increase the temperature of the body, but 
large doses reduce it by interfering with the oxygen-carrying function 
of the red corpuscles and with the nutritive process, and by dilating 
the cutaneous vessels. Respiration is first quickened, then slowed, 
and after fatal doses, paralyzed. It is a cerebral stimulant, but in 
toxic doses depresses the encephalic mass, the spinal reflex centres, 
the conductivity of both motor and sensory nerves, and finally the 
reflex functions of the medulla. It diminishes the excretion of nitro- 
genized waste, and is eliminated principally by the kidneys, lungs 
and skin, although a certain amount (more in proportion to thesmall- 
ness of the dose) disappears in the system. 

How should acute alcohol-narcosis be treated ? 

The contents of the stomach should be evacuated, ammonia or 
strychnine should be given, and the hot and cold douche alternately 
used. 

What are the medicinal uses of alcohol ? 

As a cardiac stimulant, alcohol is used in syncope from exhaustion, 
loss of blood, surgical shock and other forms of fainting, and where 
cardiac failure is threatened, as in typhoid and typhus fevers. 

As a general stimulant to the system in aMicasting diseases, as 
phthisis, scrofidei and prolonged suppuration, and in all low states of 
the system, as typhoid and typhus fevers, diphtheria, pycemia and 
septiccemia. In these fevers a tolerance to alcohol is present, and it 
may be given in large quantities without causing intoxication. It 
not only aids the digestion of food in these conditions, but as very 
little of what is taken can be found in the excretions, it seems to be 
used by the system, and consequently may be classed as a food in 
these diseases. The dose in these diseases must be regulated by the 
pulse principally. When the pulse is quickened and more bounding, 
the face flushes, the temperature rises, and the breath smells strongly 
of alcohol, the patient is taking more than the system can use, and 
the dose should be decreased. 

As 'at antidote to snakebite or other cardiac depressant, as aconite 
or veratrum viride, it is of great service. In poisoning by snake bite 



148 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

it is given in frequently repeated doses almost ad libitum, conjoined 
with intravenous or, at least, hypodermic injection of ammonia. 

To improve digestion and nutrition, it is useful in many chronic 
diseases, but the danger of forming the alcohol habit should always 
be borne in mind when it is thus prescribed. 

Locally, alcohol is used as an antiseptic and stimulant dressing for 
wounds, to harden the cuticle when bed sores are imminent, and as 
a tonic and cooling lotion. 

What are the official preparations of alcohol ? 

Alcohol Absolutum {absolute alcohol) is ethyl alcohol contain- 
ing not more than 1 per cent, by weight, of water. It is not used 
medicinally. 

Alcohol Deodoratum (deodorized alcohol) is a liquid composed 
of about 92.5 per cent, by weight, or 95.1 per cent, by volume, of 
ethyl alcohol and about 7.5 per cent, by weight of water. 

It is used in making various medicinal preparations into which 
alcohol enters. 

Alcohol (alcohol) contains 94 per cent, by volume of absolute 
alcohol; sp. gr. 0.820. 

Alcohol Dilutum {diluted alcohol) contains 48.6 per cent, by 
volume of absolute alcohol; sp. gr. 0.936. 

Spiritus Frumenti (whiskey), an alcoholic liquid obtained by the 
distillation of the mash of fermented grain (usually of mixtures of 
corn, wheat, and rye), and at least 2 years old ; it contains 50 to 58 
per cent, by volume of alcohol; sp. gr. 0.917-0.930). 

Spiritus Vini G-allici (brandy) an alcoholic liquid obtained by 
the distillation of fermented, unmodified juice of fresh grapes, and 
at least 4 years old ; it contains from 46 to 55 per cent, by volume 
of alcohol; sp. gr. 0.925-0.941. It contains some tannic acid, and 
is astringent. It is, therefore, preferable to whiskey if there is 
looseness of the bowels. It also is a stomachic sedative, and, next 
to champagne, tends to check vomiting more than any other alco- 
holic liquid. 

Vinum Album (while wine), an alcoholic liquid, made by ferment- 
ing the juice of fresh grapes, the fruit of Yitis vinifera {JVat. Ord. 
Vitacese), freed from seeds, stems, and skins, contains 10 to 14 per 
cent, by weight of absolute alcohol. 

Vinum Rubrum (red wine), an alcoholic liquid made by ferment- 



CARDIAC STIMULANTS— AMMONIUM. 149 

ing the juice of fresh colored grapes, the fruit of Vitis vinifera (Nat. 
Orel Vitaceae), in the presence of their skins, and contains from 10 
to 14 per cent, of absolute alcohol. It is somewhat astringent. 
How is alcohol administered ? 

Wines may be given pure or mixed with water. Braniy and 
whiskey are given pure or diluted with water, especially when admin- 
istered as cardiac stimulants, or in the form of milk punch or egg- 
nog, when used as a food to support the system. 

They may also be injected per rectum, and, if cardiac failure is 
imminent, brandy may be used hypodermically. 

^ETHER — ETHER. 

Is this substance ever used as a cardiac stimulant? 

The use of ether as a cardiac stimulant has already been mer> 
tioned. It acts rapidly, but transiently, and may be used internally, 
or better still, hypodermically in cases of sudden cardiac failure. 

AMMONIUM. 

What are the sources of ammonium? 

Ammonium is abundantly present in nature as the result of ani- 
mal and vegetable decay, but is chiefly obtained for commercial pur- 
poses from the ammoniacal liquor of gas works. 

What are the general physiological actions of ammonium 
preparations ? 

Ammonia Gas in solution is an irritant. Kept in contact with 
the skin it reddens and finally vesicates. When the gas is inhaled 
it irritates, producing a sense of suffocation, spasm, and, if contin- 
ued, inflammation of the air passages. When injected into the veins 
of animals in sufficient quantities, it damages the blood and causes 
convulsions, rapid respiration and death. 

Ammonia temporarily stimulates the accelerator nerves of the 
heart, thus increasing the rapidity of its action. After intravenous 
injection, the blood pressure at first falls, but rapidly rises as the 
pulse becomes quicker. It aids in maintaining the fluidity of the 
blood by retaining the fibrogenous materials in solution. In toxic 
amounts, the oxygen-carrying function of the red corpuscles is inter- 
fered with. Intra-venous injections of ammonia quicken respiration 



150 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

by powerfully stimulating the respiratory centres. The convulsions 
are due to stimulation of the motor and reflex spinal centres. It is 
eliminated chiefly by the urine as uric acid and, perhaps, as urea. 
Its salts are also eliminated by the broncho-pulmonary mucous mem- 
brane. When taken internally in medicinal doses it is antacid and 
carminative, but if continued for too long a period, it disorders di- 
gestion and causes emaciation. 

What are the symptoms and treatment of poisoning by am- 
monia ? 
When a strong solution is swallowed it causes inflammation of the 
lips, mouth, fauces, pharynx, oesophagus and stomach. GEcleina of 
the glottis may occur, and secondary strictures of the oesophagus or 
even of the pylorus may result. Death may be due to asphyxia or 
tc collapse preceded by symptoms of corrosive poisoning. The 
treatment consists in neutralizing the alkali by vegetable acids (vine= 
gar) ; protecting the injured surfaces by oils and demulcents and the 
occasional passage of an oesophageal bougie, for at least a year, to 
prevent secondary stricture. The occurrence of oedema of the glot- 
tis demands immediate tracheotomy. 

What are the therapeutical uses of the ammonium prepara- 
tions ? 

Ammonia is a rapid and powerful cardiac stimulant, but its effects 
are of brief duration. It is used for this purpose both internally 
and by inhalation in all cases of acute cardiac failure, and may be 
used to antagonize the action of snake poison andprussic acid on the 
heart, but should here be employed as an adjuvant to alcohol. 

For sudden cardiac failure during anaesthesia or from surgical 
shock it may be given hypodermically. 

It has been used by intra-venous injection to maintain the fluidity 
of the blood in cases of threatened cardiac thrombosis; and as a stimu- 
lating expectorant in pneumonia, especially when typhoid symptoms 
are present. It is given as an alkali in acidity, flatulence and in 
nervous headache. 

Ecternally it is an ingredient of stimulating and irritating lini- 
ments and may be used as a vesicant. 



CARDIAC STIMULANTS— NITROGLYCERIN. 151 

What preparations of ammonium are used as cardiac stim- 
ulants ? 

Aqua Ammonite Fortior [stronger ammonia water) contains 28 
per cent, by weight of gaseous ammonia. It is a powerful corrosive 
poison. It is best adapted for hypodermic use in doses of TiLx-xxv 
(0.6-1.5), diluted with four times its volume of water, and repeated 
in 1 5 minutes if necessary, and may be used externally as a rapid 
(but painful) vesicant by inverting a watch crystal full of it on the 
skin. 

Aqua Ammonia [ammonia water) contains 10 per cent, by weight 
of ammonia-gas; dose for internal use, gtt. x-xxx (0.6-2.0) freely 
diluted. 

Spiritus Ammonias (spirit of ammonia) contains 10 per cent, by 
weight of the gas in solution in alcohol ; dose ntx-xxx (q. 5-2. 0) 
freely diluted. 

Spiritus Ammonia Aromaticus {aromatic spirit of ammonia) 
contains also ammonium carbonate and aromatics; dose f£ss-j (2.0- 
4.0), freely diluted. 

Ammonii Carbonas (ammonium carbonate) is used as a cardiac 
stimulant, and also in threatened thrombosis. It is very valuable as 
a stimulating expectorant in capillary bronchitis, typhoid pneumonia, 
and other low forms of chronic pulmonary disease where an expec- 
torant is required. Dose gr. v-x (0.3-0.6). 

The iodide, bromide and the acetate, tartrate, and citrate of iron 
and ammonium, and valerianate of ammonium have already been 
noticed ; the acetate, benzoate and chloride will be discussed here- 
after. The nitrate of ammonium is only used in making other 
official preparations. 

AMY! NITRIS — AMYL NITRITE— 
NITROGLYCERIN. 

Are these substances used as cardiac stimulants ? 

Inhalations of amyl nitrite have been employed in cases of sudden 
heart-failure, as in fatty heart, or during anaesthesia. Nitroglycerin 
has been used also as a cardiac stimulant, especially in cases associ- 
ated with high arterial tension. These remedies have been discussed 
under the head of Depresso-Motors. 



152 ESSENTIALS OP MATERIA MEDIC A AND THERAPEUTICS. 
ATRO PINJE — ATROPINE. 

Is atropine used as a cardiac stimulant ? 

Atropine [vid. belladonna^. 107) is used as a cardiac stimulant in 
cases of sudden or threatened heart-failure. Dose gr. rzo~Fij (0- 0005- 
0.001), given hypoder in ically. 

DIGITALIS. 

What is digitalis ? 

Digitalis is the leaves of D. purpurea, or purple foxglove (Nat. 
Ord. Scrophularineae), obtained from plants of the second years 
growth. It is a European plant, cultivated in this country. 

What are its chemical constituents ? 

The constituents of digitalis* are, digitalin, digitalosmin (stear- 
opten), digitaleic acid, resin, mucilage, etc. " Commercial digitalin 
is a mixture of several compounds of which the following have been 
investigated to some extent:'' Digitoxin ; Digitonin, a crystallizable 
glucoside, is decomposed by warm hydrochloric acid into dextrose, 
galactose and digitogenin ; Digitalein ; Digitalin, and Digitin. 
All these principles except the last are cardiac poisons. 

What are the physiological effects of digitalis? 

Its effects are much more slowly produced, but are much more 
lasting than those of the medicines previously considered, and it is 
therefore more of a tonic than a stimulant to the heart. In moderate 
doses it slows and strengthens the cardiac beat, elevates the blood 
pressure and causes diuresis. It sometimes interferes with the 
appetite and digestion. After very large doses, or when too long 
continued, nausea and vomiting may occur ; the pulse becomes 
dicrotic, weak, and sometimes rapid, and diaphoresis more or less 
profuse takes place. Toxic doses cause the same symptoms, and 
in addition vertigo, disordered vision, lowered reflexes, muscular 
tremors, lassitude, reduced temperature, delirium, stupor, usually 
convulsions, and death from cardiac paralysis. 

In moderate doses it stimulates the peripheral cardio-inhibitory 
fibres of the vagi (thus slowing the heart by increasing the length of 

* A Manual of Organic Materia Mediea, by John M. Maisch, Ph. M., 
Pharm. D., 6th ed., 1895, pp. 228, 229. 



CARDIAC STIMULANTS— DIGITALIS. 153 

the diastole), the cardiac muscle and its contained motor ganglia 
(thus increasing the strength and force of the systole), and the vaso- 
motor centres (thus raising the arterial tension). It also acts directly 
on the muscular walls of the vessels, and thus lessens their calibre. 

When full medicinal doses are taken, or when the pulse has been 
greatly slowed by it, a sudden change from the recumbent to the 
erect posture may give rise to a small, weak, rapid pulse, with low- 
ered arterial tension. 

When fatal doses are taken the heart is arrested in systole. 

In poisonous doses it lowers reflex action by stimulating Setsche- 
now's inhibitory reflex centres and, later, by paralyzing directly the 
spinal cord. It also lowers the contractility of muscles. It usually 
proves diuretic, probably from elevating the arterial tension. It is 
eliminated chiefly by the urine. 

How should poisoning" by digitalis be treated ? 

(1) Give emetics and cathartics to remove the poison from the 
alimentary canal ; (2) tannic acid as a chemical antidote ; alcohol, 
ammonium carbonate and opium, or saponin, as physiological antago-' 
nists. 

What are the medicinal uses of digitalis ? 

As a cardiac tonic digitalis is used in all cases of loss of cardiac 
power, as in dilatation or in weakness of the cardiac muscle. It 
should never be prescribed in simple hypertrophy, nor when hyper- 
trophy is sufficient to compensate for valvular lesion. In advanced 
cases of fatty heart, it should be used very cautiously, if at all, as 
the increased systolic power which it induces may lead to rupture ol 
the friable cardiac walls. In valvular diseases, when the hyper- 
trophy is not compensatory, or when dilatation is taking place, it is 
invaluable. In "irritable heart ," functional palpitation and venous 
engorgements (by lengthening the diastole it allows the veins more 
time to empty their contents into the auricles), it is much used. 
The tincture (HLx-xx (0.6-1.2)) may be employed hypodermically in 
cases of sudden cardiac failure. To sustain the action of a depressed 
heart in various acute diseases, particularly in pneumonia, it is often 
administered. 



154 ESSENTIALS OP MATERIA MEDICA AND THERAPEUTICS. 

In delirium tremens, where the pulse is soft and compressible, 
digitalis is often given in large doses with benefit. 

It is also used as a physiological antidote to poisoning by aconite, 
delphinine and muscarine, all of which arrest the heart in diastole. 

To contract the blood vessels it has been used in acute inflamma- 
tions and in hemorrhages, and as it is supposed to stimulate involun- 
tary muscle-fibres generally, it is given in menorrhagia and in sper- 
matorrhoea. 

As a cardiac tonic and diuretic it is used in all forms of cardiac 
and of renal dropsy, in acute suppression of urine and in acute des- 
quamative nephritis. 

What are the preparations of digitalis, and how are they 
administered? 

Digitalis leaves are sometimes given in powder or pill, dose 
gr. j (0.06) t. i. d., gradually increased. The official prepara- 
tions are — 

Extractum Digitalis {extract of digitalis), dose gr. \ (0.016), 
gradually increased. 

Extractum Digitalis Fluidum [fluid extract of digitalis), dose 
«\j (0.06). 

Tinctura Digitalis {tincture of digitalis), dose ^Iv-x (0.3-0.6), 
gradually increased. 

Infusum Digitalis {infusion of digitalis), one of the best prep- 
arations; dose f^ss-jv (2.0-15.0). 

Occasionally after digitalis has been taken for some time continu- 
ously, especially when free diuresis has not taken place, its action 
becomes suddenly manifested by the pulse rapidly falling and the 
supervention of other effects characteristic of the drug. This is 
probably due to some delay in the absorption or elimination of the 
medicine, and when it occurs the remedy should be promptly dis- 
continued. So-called commercial digitalin should never be pre- 
scribed because of its variable composition. Mercies German digi- 
talin is a stable and valuable remedy, representing the full value of 
digitalis, without its irritating effects upon the digestive tract. Dose 
gr. £rl (0.006-0.03). 



CARDIAC STIMULANTS— CAFFEINE. 155 

CAFFEINA — CAFFEINE. 

What is caffeine ? 

Caffeine [theine) is a feebly basic, proximateprinciple, obtained from 
the dried leaves of Thea sinensis or tea plant {Nat. Orel. Ternstrse- 
niiaceae), from the dried seeds of Coifea arabiea or coffee plant ( Nat. 
Ord. Rubiaceae), or from guaraua (a paste prepared from the 
crushed or ground seeds of Paullinia cupana (Nat. Ord. Sapindaceae). 
Guarana is official.) 

What are its physiological actions ? 

In medicinal doses, caffeine is a cerebral stimulant, causing ner- 
vous restlessness, increased mental activity and wakefulness; it also 
increases the cardiac force, raises the arterial pressure, and acts as a 
decided diuretic. After poisonous amounts, there is also confusion 
of thought, with delirium, muscular tremblings, cardiac oppression, 
quickened respiration, cold extremities, symptoms of collapse, rise 
of temperature, and (in animals) tonic and clonic convulsions, mus- 
cular weakness, general paresis, and death from paralysis of respiration. 

It increases the power of the heart and raises arterial tension, 
probably by a direct stimulant effect upon the heart muscle. It is 
diuretic, not only indirectly by increasing the blood pressure, but also 
by some direct action on the secreting cells of the kidney itself. The 
convulsions are probable due to spinal stimulation. In moderate 
doses, caffeine is said to be entirely destroyed in the system ; in 
toxic doses, it is partly destroyed and partly eliminated by the 
kidneys. Its effect on the elimination of waste products is at 
present uncertain. 

What are its medicinal uses ? 

As a cardiac tonic (more rapid in action, but not so enduring as 
digitalis), it is used to meet the same indications which call for the 
use of digitalis. In cases of sudden heart failure, it may be used 
hypodermically combined with equal parts of sodium salicylate, 
which renders it more soluble in water. 

As a combined cardiac stimulant and diuretic it is very useful in 
the latter stages of chronic B right's disease with weak heart. 

As a diuretic in all renal and cardiac dropsies it is very service- 
able. It is also employed as a cerebral stimulant in nervous and 
neuralgic headaches, and combined with other antagonists in opium 
poisoning. 



156 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

How is caffeine administered ? 

Caffeina ( Caffeine) may be given in pill, capsule or solution', 
dose gr. j-v (0.06-0.3) or more. For administration in fluid form 
caffeine citrate (so-called) is preferred as more soluble. 

When given as a cerebral stimulant, one dose of gr. ij-v (0.13-0.3) 
is usually sufficient, but as a cardiac tonic and diuretic this dose 
should be repeated twice daily, and gradually increased if necessary 
up to gr. x-xij (0.6-0.8). 

Caffeina Citrata {titrated caffeine), dose gr. ij-v (0.13-0.3). 

Caffeina Citrata Effervescens (effervescent titrated caffeine), 
dose 3j-iij (4.0-12.0). 

Guarana {Guarana) contains tannic add, as well as caffeine in 
considerable quantities, and is principally used in neuralgic and in 
sick-headache. In Brazil, whence it comes, it is also used as an 
astringent in diarrhoeal affections, dose 3.) (4.0). 

Extractum Guarana Fluidum (fluid extract of guarana), dose 
ffU-xx (0.6-1.2). 



ADONIDIN. 

What is adonidin? 

Adonidin (not official) is a glucoside, obtained from the root of 
Adonis vernalis (Nat. Orel. Ranunculaceae), a plant of northern and 
central Europe. 

What are its effects, uses and modes of administration? 

The effects of adonidin are almost identical with those of digitalis 
(but are much more quickly produced), as it stimulates the cardiac 
muscle and contained motor ganglia, thus increasing the force of 
the cardiac contractions at the same time that, by stimulating the 
inhibitory fibres of the vagi, it increases the length of the diastole 
and thus slows the heart. The arterial tension is also elevated, prob- 
ably by stimulation of the vaso-motor centres. In large doses it 
paralyzes both the heart and vessels, the arterial tension falls and 
the heart is finally arrested in diastole. It sometimes (not as fre- 
quently as does digitalis) causes nausea, vomiting and diarrhoea. It 
sometimes proves diuretic. It is used as a cardiac tonic in the same 
class of diseases in which digitalis is employed, and may be substi- 
tuted for it where the latter disagrees or is too slow in its action. 



CARDIAC STIMULANTS— SPARTEINE SULPHATE. 157 

It may be alternated with digitalis for a few weeks during a 
course of the latter. Dose gr. %-% (0.008-0.03) every 3 or 4 hours, 
in pill or capsule. 

STROPHANTHUS. 

What is strophanthus ? 

Strophanthus is the seed of S. hispidus {Nat. Ord. Apocynacese), 
an African plant which has been used by the natives as an arrow- 
poison, and called by them Kombe or Inee. It contains a crystal- 
line glucoside, called strophanthin. 

What are its effects, uses and modes of administration ? 

The effects of strophanthus are more rapid in action, but much 
more evanescent, than those of digitalis. It appears to act upon the 
muscles directly, and to have little or no effect upon the nervous 
system. 

In moderate doses it greatly increases the strength of the cardiac 
systole, prolongs the diastole and increases the arterial tension proba- 
bly by acting on the muscular walls of the vessels. In large doses 
it increases the contractibility of all the striated muscles and finally 
arrests the heart in systole. 

It proves diuretic by increasing the arterial tension, and has no 
cumulative effects. It is used as a substitute for digitalis in cardiac 
diseases when a temporary effect or a temporary change of medi- 
cines is desirable. From its diuretic action it has been successfully 
employed in various forms of oedema depending on a weak circula- 
tion and general cardiac and renal dropsies. The tincture of stro- 
phanthus (tiuctura stroplianthi — 5 per cent, by weight) is used; 
dose nij-x (0.06-0.6) t, i. d. ; or strophanthin may be cautiously 
administered hypodermically ; dose gr. t^o~wu (0.0006-0.001). 

SPARTEINE SULPHAS — SPARTEINE SULPHATE. 

What is sparteine ? 

Sparteine is a liquid alkaloid obtained from Cytisus Scoparius, or 
broom (Nat. Ord, Leguminosse). 

What are its effects and uses, and how is it administered ? 

Sparteine is a cardiac tonic, in moderate doses increasing the force 
and persistence of the cardiac contractions by direct action upon the 



158 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

heart or its contained motor ganglia, and at first increasing its fre- 
quency by paralyzing the vagi, afterward decreasing the pulse-rate 
by its direct action on the heart, When the cardiac rhythm is dis- 
turbed it renders its contractions regular. In large doses it depresses 
the heart and causes death from paralysis of the respiratory centre. 
It depresses the cerebral and spinal centres. It has no diuretic 
properties. It has been used as a substitute for digitalis in cardiac 
diseases, and in cases of feebleness and irregularity of cardiac action- 
It is inferior to digitalis as a cardiac tonic, but may be used as a suc- 
cedaneum to it. It is administered in the form of sulphate (official), 
of which the dose is gr. 2V"? (0.003-0.01), hypodermic-ally ; or if 
given internally, gr. J-j or ij (0.01-0.06-0.13) in capsule or pill. 

STRYCHNINA — STRYCHNINE. 

Is strychnine prescribed for its cardiac effects ? 

The use of strychnine as a cardiac tonic has been noticed under 
the head of nux vomica {q. v.) ; dose gr. ^Wo (0.002-0.003) inter- 
nally, or gr. sir (0.001) if used hypodermically. 

CIMICIFUGA. 

What is cimicifuga ? 

Gimicifuga is the rhizome and roots of C. racemosa, black snake- 
root or cohosh [Nat. Ord. Ranunculaceae), a common indigenous 
plant, It contains a volatile oil, to which its virtues are probably 
due. A crystalline principle has also recently been obtained from it. 
Its effects on the circulation are supposed to resemble those of 
digitalis, while it acts on involuntary muscular fibres similarly to 
ergot. Recently it has been said, however, that it is a direct 
depressant to the cardiac muscle or its ganglia. It depresses the 
reflexes and occasionally causes nausea and vomiting. Its action is 
mild and not well understood. It is also diuretic and expectorant. 
It has been used as a cardiac tonic in fatty heart, as a diaphoretic in 
rheumatism, as a diuretic in dropsies, as an expectorant in chronic 
bronchitis, and as an antispasmodic in chorea, in which disease it is 
sometimes of value, combined with tonics and laxatives. It is not 
often prescribed. 

Extractum Cimicifuga Fluidum {fluid extract of cimicifuga), 
dose fcss-j (2.0-4.0). 



CARDIAC SEDATIVES — ANTIMONY. 159 

TlNCTURA Cimicifuga {tincture of cimicifuga), dose f3ss-ij (2.0- 
8.0). 

Extractum Cimicifuga {extract of cimicifuga), dose gr. iij-v 
(0.2-0.3). 

CONVALLARIA. 

What is convallaria ? 

Convallaria is the rhizome and roots of C. majalis, or lily of the 
valley {Nat. Ord. Liliacese), a European plant naturalized in this 
country. 

It contains two glucosides, convallamarin and convallarin, to the 
former of which it probably owes its action on the heart, while the 
latter appears to cause nausea, diarrhoea and gastric pain. 

The results of the investigations regarding the physiological action 
of this plant are very contradictory, but it seems to slow the heart 
and increases the blood- pressure in small doses. In toxic doses the 
cardiac action becomes rapid, the arterial pressure gradually falls, 
and death occurs from heart-failure. 

It is used in all cases of cardiac weakness whether accompanied 
by valvular lesion or not, as in dilatation or fatty heart. It is also 
used in palpitation. 

Extractum Convallaria Fluldum {fluid extract of conval- 
laria), dose tt\,v-xv (0.3-0.9). 

ORDER II.— Cardiac Sedatives. 

What are cardiac sedatives ? 

Cardiac sedatives are medicines which are used to diminish the 
force and frequency of the cardiac contractions when they are mor- 
bidly increased, and thus to depress the circulation. 

Name the principal cardiac sedatives. 

Antimonials, aconite and its alkaloid, veratrum viride and its 
alkaloids, veratrine, gelsemium, Pulsatilla, arnica, the vegetable 
acids. 

ANTIMONIUM — ANTIMONY . 

What are the sources of antimony ? 

Antimony is a metallic element found native in the form of black 
antimonious sulphide. 



160 ESSENTIALS OP MATERIA MEDIC A AND THERAPEUTICS. 

Mention some of the tests for antimony. 

Sulphuretted hydrogen iu solution forms with solutions of anti 
inonial salts an orange-colored precipitate. The metal should also 
be reduced by Marsh's test, and chemically and microscopically dis- 
tinguished from arsenic. 

What are the general physiological effects of antimonials ? 

When applied locally to the skin, the salts of antimony produce 
an eruption of papules, which become pustules, somewhat resembling 
the eruption of smallpox. After prolonged use, the fauces some- 
times present a similar eruption. Internally, in small doses, they 
are diaphoretic. In somewhat larger doses, they cause nausea, 
depressed circulation, weakness, and increase of the mucous and 
cutaneous secretions. In large doses, they prove emetic, with very 
weak pulse, great general depression and relaxation of the muscular 
system. In poisonous doses, they are gastro-intestinal irritants, 
causing emesis, catharsis with cramps in the extremities, and col- 
lapse, often resembling Asiatic cholera, and death from asthenia, 
sometimes preceded by tonic and clonic spasms. 

Antimonials slow the heart, increase the duration of its diastole 
and diminish the force of its systole by direct depression of the 
cardiac functions ; they lower the blood pressure partly by cardiac 
depression and partly by paralyzing the peripheral vaso-motor sys- 
tem. The pulse finally becomes rapid and very feeble, the pressure 
sinks almost to nil and the heart is arrested in diastole. They 
depress and paralyze the reflex, sensory, and, to a less extent, the 
motor functions of the spinal cord. The temperature is reduced by 
poisonous doses. The emesis is probably partly from local and partly 
from centric irritation. 

When given for a length of time, they cause fatty degeneration of 
various viscera. 

Antimony is eliminated by the mucous membranes, especially of 
the stomach, by the liver, kidneys and skin. 

What is the treatment of poisoning by antimony? 

Wash out the stomach to remove any poison present ; give tannic 
acid as a chemical antidote, and opium and stimulants to overcome 
the resulting depression. 



CARDIAC SEDATIVES— ANTIMONY. 161 

What are the medicinal uses of antimonials ? 

They are used as cardiac sedatives in the early stages of acute 
sthenic inflammations, but are probably inferior to aconite or vera- 
trum viride for this purpose. They are very useful in the early 
stages of acute bronchitis and in acute laryngitis from their com- 
bined sedative, diaphoretic and expectorant qualities. As dia- 
phoretics they are used in minute doses, frequently repeated, in fever 
mixtures, or combined with minute amounts of morphine, which 
increases their action. The depression which they produce should 
always be remembered. 

As nauseants and emetics they are rarely resorted to, because of 
the great depression which they produce. 

Sulphurated antimony, or the old Kermes mineral, is sometimes 
used as a nauseant in membranous croup. 

Locally, as a counter-irritant it is rarely employed. 

What are the antimonial preparations? 

Antimonii et Potassii Tartras (antimonium and potassium 
tartrate — tartar emetic — tartarated antimony) ; dose, as a sedative, 
gr. k~k (0.01-0.03), increased to gr. j-ij (0.06-0.12), as tolerance to 
its action is established ; as a diaphoretic and expectorant, gr. j^-J 
(0.004-0.016), in solution, repeated every 2 or 3 hours until the 
desired results are produced ; as an emetic, gr. j-ij (0.06-0.13). 

VlNUM Antimonii {wine of antimony) contains 4 parts of tartar 
emetic in 1000 of the preparation (about gr. ij-f3j). Dose as a 
diaphoretic and expectorant n^x-xxx (0.6-2.0); as an emetic f3j-iv 
(4.0-15.0). 

SYRUPUS SciLLiE COMPOSITUS {compound syrup of sqnrfl— 
Coxes hive syrup) contains tartar emetic, 2 parts in 1000 of the 
preparation (about gr. j to the f^j). It is used in croup as an 
emetic and also as an expectorant ; dose ttlv-f3j (0.3-4.0). 

The following preparations are somewhat uncertain, and are rarely 
employed : — 

Antimonii Oxidum {antimonious oxide), dose gr. j-ij (0.06-0.13). 

PULVIS Antimonialis {antimo)tial j)oirder — James powder) con- 
tains antimonious oxide 33 per cent, with precipitated calcium phos- 
phate; dose gr. iij-x (0.2-0.6). 
11 



162 ESSENTIALS OF MATERIA MEMCA AND THERAPEUTICS. 

Antimonh Sulphidum (antimonious sulphide) and Antimonh 
Sulphidum Purificatum ( purified antimonious sidphide) are used 
in making the other preparations. 

Antimonh Sulphuratum {sulphurated antimony — Kermes min- 
eral), dose gr. j-iij (0.06-0.2) ; as an emetic gr. v-x (0.3-0.6). 

Pilule Antimonh Composite {compound pills of antimony— 
Hummer's pill). Used as an alterative. Each pill contains of 
calomel and sulphurated antimony each gr. ^ (0.04). 

ACONITTJM — ACONITE. 

What is aconite, and what is its chemical composition ? 

Aconite is the tuber of Aconitum Napellus, aconite, monkshood 
or wolfsbane (Nat. Ord. Ranunculaceae), a native of the mountains 
of Europe and Asia. The active principle is an alkaloid called 
aconitine. Other alkaloids have been discovered in it, viz. : aconine, 
isaconitine, and picraconatine. 

What are its physiological effects ? 

Locally applied, aconite or aconitine benumbs the sensory nerves 
and causes a sensation of tingling. Internally in small doses it les- 
sens the force and frequency of the cardiac contractions, diminishes 
the blood pressure, causes tingling in the lips, tongue and extremi- 
ties and produces a feeling of weakness. When large doses are 
taken, these symptoms are more marked, the pulse becomes very 
weak and slow, a tendency to fainting is manifested on assuming the 
erect posture or on any exertion, and the respirations are reduced in 
number. After poisonous doses these symptoms are much intensi- 
fied ; the countenance is anxious, a cold sweat covers the body, the 
pulse and respiration are very slow, weak and irregular, general 
anaesthesia is present, and collapse and death from syncope, some- 
times preceded by convulsions, occur. 

Aconite affects the heart by directly depressing the cardiac muscle, 
and its contained motor ganglia. It probably also stimulates the 
cardio-inhibitory apparatus, but does not affect the vaso-motor 
nerves or centres. It paralyzes the peripheral end organs of both 
motor and sensory nerves, the latter being first affected by it, and 
the nerve trunks and centres being only involved as the poisoning 
deepens. The loss of reflex function is probably due to interference 



CARDIAC SEDATIVES— ACONITE. 163 

with conduction. It depresses and finally paralyzes the respiratory 
centre. 

What is the treatment of poisoning- by aconite ? 

Evacuate the contents of the stomach and wash it out by means 
of the stomach pump ; keep the sufferer perfectly quiet, with his 
head low ; give cardiac stimulants, as alcohol, ether or ammonia, 
and administer digitalis hypodermically. 

What are the medicinal uses of aconite ? 

As a cardiac sedative aconite is of great value in the early stages 
of all acute inflammations and all fevers, in which the patient is 
vigorous and young and the pulse tense, full, bounding and strong, 
and is only contraindicated when the heart is weak, when there is 
gastro-enteric inflammation, or where a typhoid condition is present. 
Thus it is used to diminish the circulation, arterial tension and tem- 
perature, and to promote diaphoresis and diuresis in the sthenic 
forms of surgical fever, in acute coiijza, acute broncho-pulmonary 
catarrhs, acute pleuritis and acute peritonitis, in acute meningitis 
either cerebral or spinal, and in the essential fevers, when not of the 
asthenic type. In scarlet fever and in measles (when the tempera- 
ture is high), it is of great value, and is often used during the exa- 
cerbations of remittent malarial fevers. In lobar pneumonia vera- 
trum viride is a safer remedy, but aconite will prove very serviceable 
if employed with great caution before consolidation has taken place. 

In cardiac hypertrophy uncomplicated by valvular lesion, or even 
if the latter is present, provided the hypertrophy be in excess of the 
requirements of the system, it is an invaluable medicine. 

As a local anaesthetic it has been advantageously given internally 
and applied externally in neuralgia, particularly of the face and 
head, and has been used locally in chronic muscular rheumatism 
and in rheumatic neuralgia?. 

What are the preparations of aconite and their doses ? 

Extractum Aconiti {extract of aconite), dose gr. J-ss (0.008- 
0.03). 

Extractum Aconiti Fluidoi (fluid extract of aconite), dose 
TTlss-ij (0.03-0.123). 

Tinctura Aconiti (tincture of aconite), dose ny-v (0.06-0.3), 
frequently combined with other medicines in fever mixtures. 



164 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

In fevers and inflammations aconite is preferably given in small 
doses, repeated every few hours, and carefully watched, until its 
effects on the pulse are obtained. 

Aconitine is not official and should not be used internally, as even 
in the minutest doses it is a powerful poison. Duquesnel's aconitine 
has, however, been administered with great care in tic douloureux 
with success. Dose gr. zho-^ho (0. 0002-0. 0003). Morson's aconite is 
probably even more powerful. Aconitine is used locally as an 
anodyne in neuralgia, in the form of liniment (gr. ij (0.13)-f3j (4.0)) 
or as an addendum to ointments. 

VERATRUM VIRIDE. 

What is veratrum viride, and what does it contain ? 

It is the rhizome and roots of Veratrum viride, American or 
swamp hellebore or Indian poke (Nat. Ord. Liliaceas), a plant 
indigenous to swampy places in the eastern part of the United States. 
It contains two alkaloids, veratroidine and jercine, to which its effects 
are due ; also rubijervine, pseudojervine, resin, etc. 

What are their physiological effects ? 

Jervine taken internally causes great weakness, depresses the spinal 
cord and lowers reflex action, lessens the force and frequency of the 
heart by direct action on the cardiac muscle or its contained motor 
ganglia, greatly reduces the blood pressure, both by its action on the 
heart and by depressing and finally paralyzing the vaso-motor centres, 
causes profuse salivation, and death from asphyxia, preceded by 
convulsions of cerebral origin. 

Veratroidine gives rise to the same general effects, but in addition 
always produces vomiting and often purging. When directly applied 
to the heart muscle, it paralyzes it. Given internally, it first slows 
the heart and lowers the blood pressure by stimulating the vagus, 
then, the pulse remaining slow, the heart-beats increase in force and 
the blood pressure rises to normal, but suddenly, from peripheral 
paralysis of the vagi, the cardiac action becomes very rapid and 
diminishes in force, and, as asphyxia increases, the arterial tension is 
much elevated. Death is due to paralysis of the respiratory muscles. 

Veratrum viride combines the effects of its alkaloids, and is a 
powerful arterial and spinal depressant, diminishing the frequency 



CRADIAC SEDATIVES —VERATRINE. 165 

and force of the cardiac contractions, by depressing the heart muscle 
and stimulating inhibition, and lowering the blood pressure by para- 
lyzing the vaso-motor system. It often causes vomiting. It is a 
diaphoretic, reduces the temperature, and sometimes proves diuretic. 
Poisoning rarely occurs, as an overdose causes emesis. Should dan- 
gerous symptoms arise, they should be treated with alcoholic and 
other cardiac stimulants. 

What are the medicinal uses of veratrum viride ? 

It is given as a cardiac sedative in the same inflammatory and 
cardiac affections in which aconite is administered, and its contra- 
indications are identical with those of the latter drag, with the addi- 
tion that in peritonitis it is not a safe remedy, because of its liability 
to cause vomiting. In acute lobar pneumonia it is considered much 
safer than aconite. In acute mania and in mania -a-potu (when the 
patient is strong and the pulse full and bounding), it is a valuable 
medicine, but should never be given in delirium tremens. It has 
been highly recommended in puerperal eclampsia, in doses of "H^x- 
xx (0.6-1.2) of the tincture, given hypodermic-ally, partly as an 
arterial sedative and partly as a reflex depressant. 

What are its preparations and their doses ? 

Extractum Veratri Viridis Fluidum {fluid extract of vera- 
trum viride), dose n\j-iv (0.06-0.24). 

Tinctura Veratri Viridis {tincture of veratrum viride), NUj-x 
(0.123-0.6). 

Its effects are better obtained by giving small and increasing doses 
at intervals of an hour, being careful not to cause vomiting, and 
closely watching the pulse. 

VERATRINA— VERATRINE. 

What is veratrine ? 

Veratrine is a mixture of alkaloids obtained from the seed of 
Asagraea officinalis (Nat. Ord. Liliaceae), a Mexican plant. 

How may its presence be detected ? 

When warmed in concentrated hydrochloric acid a persistent 
dark-red color is produced, resembling a strong solution of potassium 
permanganate. This is Trapps test for veratrine. 



166 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are its physiological actions ? 

Locally veratrine is irritant, causing heat and pain, followed by 
numbness, and if long applied, redness of the surface. After small 
doses the pulse is weakened and reduced in frequency. Large doses 
are followed by vomiting and purging and muscular weakness ; with 
cold, clammy skin ; weak, rapid, irregular pulse and muscular 
tremors. Veratrine appears to stimulate the excito-motor cardiac 
ganglia and muscle (temporarily increasing the pulse), but soon 
depresses, and finally paralyzes them. It excites and then destroys 
the function of the vagi (thus lessening the pulse-rate, which, how- 
ever, in poisoning, become rapid again as the vagi are paralyzed). 
The vaso-motor centres are first stimulated, then depressed. It first 
stimulates and then depresses the nerve trunks (or their peripheral 
end-organs) and the muscles, without apparently affecting the cere- 
brum or spinal cord. It depresses and finally paralyzes the respira- 
tory centre, death occurring from this cause. The temperature is 
also lowered. It is eliminated chiefly by the skin and kidneys, in- 
creasing their secretion. 

No fatal case of poisoning is recorded ; the treatment is the same 
as that employed in poisoning by veratmrn viride. 

What are its therapeutic uses and preparations ? 

Although it has been used as a cardiac depressant, yet as it is in- 
ferior in this respect to the remedies already considered, it is now 
but little given internally. It is chiefly used as an external applica- 
tion in rheumatic pains and in neuralgia. 

Unguentttm Veratrine {ointment of veratrine) contains 4 per 
cent, of veratrine. 

Oleatum Veratrine (oleate of veratrine) contains 2 per cent, 
of veratrine. 



GELSEMIUM. 

Is gelsemium used as a cardiac sedative ? 

It has been employed for this purpose in sthenic inflammation 
and fevers. Its medicinal uses have been described among the 
depresso-motors. 



CARDIAC SEDATIVES— ARNICA. 167 

PULSATILLA. 

What is Pulsatilla ? 

It is the herb of Anemone Pulsatilla and A. pratensis (Nat. Orel. 
Ranunculaceae), and contains a volatile oily substance which when 
kept decomposes, forming auemonin and anemonic acid. 

What are its effects and uses ? 

Locally Pulsatilla is irritant ; internally it depresses the circulation 
and lowers the blood-pressure, and in poisonous doses causes vomit- 
ing and purging, dilated pupils, convulsions, paralysis, diminished 
sensation, coma and death. It is eliminated by the kidneys. Pul- 
satilla is not much used, as it is decidedly inferior to other cardiac 
sedatives. It may be given in doses of gr. j-v (0.065-0.324) in 
powder, pill, capsule or infusion, or a tincture or fluid extract may 
be prepared. 

ARNICA 

What is arnica ? 

It is the flower-heads and the rhizome and roots of Arnica mon- 
tana, leopard's bane (Nat. Ord. Compositae). It contains arnic*«, a 
volatile oil, resins, etc. 

What are its effects and uses ? 

Locally applied arnica is a stimulant and often a decided irritant. 
Internally it slows the heart, but seems to raise the arterial pressure 
slightly. In large doses it is emetic and cathartic, causes great 
muscular weakness, a rapid pulse, and if the dose be excessive, col- 
lapse. It seems to be eliminated by the skin and kidneys. Arnica 
is not much used in this country except as an external application to 
sprains and contusions. When thus employed its irritant qualities 
should be borne in mind. The preparations are : — 

Extractum Arnic;e Kadicis [extract of arnica root), dose 
gr. v-x (0.324-0.648). 

Extractum Arnic^e Badicis Fluidum {fluid extract of arnica 
root), dose tt\,x-xx (0.6-1.2). 

Tinctura Arnic^e Eadicis {tincture of arnica root) and Tinc- 
tura Arnic^e Floroi (tincture of arnica floicers), dose ttlx-xxx 
(0.6-2.0). 

Emplastrum Arnica {plaster of arnica). 



168 essentials of materia medlca and therapeutics. 

The Vegetable Acids. 
Name the vegetable acids. 

The officinal vegetable acids are : acetic, citric and tartaric acids. 

What are their general effects and uses ? 

When applied to an abraded surface they are irritant (tartaric acid 
being most, and citric the least, powerful). Given internally they 
increase the saliva and thus diminish thirst in fever. In large doses 
they are gastro-intestinal irritants and cardiac sedatives. They are 
probably oxidized in the blood and converted into carbonic acid, 
which by abstracting part of the base of the alkaline phosphates, 
converts them into acid phosphates, thus increasing the acidity of 
the urine. When taken in large quantities they cause flatulence, 
tormina and diarrhoea. Their long-continued use disorders the 
digestion, and causes emaciation and an anaemic condition. They 
are eliminated, chiefly as carbonates, by the intestines and kidneys. 

The vegetable acids are used as refrigerants and perhaps cardiac 
sedatives in fevers (citric acid), as antiscorbutic agents (citric or 
acetic acid), in acute rheumatism (lemon juice is, however, inferior 
to the alkaline treatment), in indigestion depending on superacidity 
of gastric juice (lemon juice before meals), and as diuretic to in- 
crease the amount of urine, and render it acid in reaction (tartaric or 
citric acid). 

They are also used as chemical antidotes to poisoning by the alkalies. 

Locally acetic acid is used as a caustic to remove corns and warts, 
as a stimulating liniment in sprains, as an injection in vaginal leu- 
corrhcea, and diluted with water it is given per rectum to destroy 
ascarides, and as a cooling lotion in fevers. The preparations are — 

Acidum Acettcum GrLAClALE {glacial acetic acid) (nearly or quite 
absolute acetic acid) and Acidum Aceticum {acetic acid) (containing 
36 per cent, by weight of absolute acetic acid) are used externally 
as caustics. 

Acidum Aceticum Dilutum {diluted acetic acid) may be used 
internally; dose f3j-ij (4.0-8.0) diluted. It is a pure form of 
vinegar. 

Acidum Citricum {citric acid), 5j (31.0) to water Oj (480.0), 
may be used as a substitute for lemonade. 



APHRODISIACS. 169 

Syrupus Acidi Citrici {syrup of citric acid) contains 10 parts 
of the acid in the 1000 of the preparation. 

Limonis Succus {lemon-juice), Oleum Limonis [oil of lemons), 
and Spiritus Limonis {spirit of lemon— essence of lemon) are also 
official. 

Acidum Tartaricum {tartaric acid) is rarely used in medicine, 
except as an ingredient of Seidlitz powders. 



(C) ON THE SEXUAL ORGANS. 

ORDER I.— Aphrodisiacs. 
What are aphrodisiacs? 

Aphrodisiacs are medicines used to excite the functions of the 
genital organs when they are morbidly depressed. 

What medicines are used for this purpose ? 

When the nutritive functions are not properly performed, the 
tonics or alteratives, especially phosphorus, zinc phosphide, the phos- 
phates and hypophosphites, the salts of iron, gold or arsenic, and 
cod-liver oil are used. When there is an absence of sexual desire, 
small doses of opium, very minute amounts of alcohol, cannabis In- 
dica, musk, or small doses of camphor may be useful by stimulating 
the cerebral centres. If impotence be due to want of erectile power, 
the tonics and alteratives are of use, as are also agents acting on the 
genital centre in the lumbar portion of the spinal cord and agents 
which either determine a flow of blood to the part by increasing the 
general or local circulation or which, by contracting the veins, aid in 
producing and maintaining erection. Thus, nux vomica or its alka- 
loid, the cardiac stimulants, hamamelis, ergot, cantharides and 
myrrh are useful in this condition. Good hygiene, cold baths, 
proper food and sea air and bathing, electricity, and moral means 
are important. The above medicines have either been considered 
already or will be found in their appropriate places. 



170 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

ORDER II. — Anaphrodisiacs. 
What are anaphrodisiacs ? 

Anaphrodisiacs are medicines which are used to depress the sexual 
functions when they are morbidly excited. 

What medicines are employed for this purpose ? 

Morbid excitation of the sexual organs is treated by medicines 
which depress the functions of the body generally, as nauseants and 
purgatives, or those which, by depressing the brain or spinal cord, 
will prove sedative to centres governing these organs : thus full doses 
of opium or of camphor will depress the cerebral centre, while potas- 
sium or ammonium bromide (very useful), monobromated camphor, 
iodine and the iodides, potassium nitrate, ammonium chloride, bel- 
ladonna, tobacco, and conium act more especially on the spinal cen- 
tre and nerves. Medicines diminishing the circulation of the parts 
will also prove advantageous, as the cardiac sedatives or full doses of 
digitalis and the bromides. Cocaine locally applied acts by contract- 
ing the vessels and diminishing the secretions of the sensory nerves. 

Other agents used for this purpose are the local use of cold, gen- 
eral blood-letting, a low diet, avoidance of stimulation, and the with- 
drawal of blood to other parts of the body, as by hard mental work 
or exercise with the upper extremities. 

ORDER III.— Oxytocics. 
What are oxytocics ? 

Oxytocics are medicines which are employed to increase the power 
of a contracting uterus, thus aiding in the expulsion of its contents. 

Name the medicines belonging to this order. 

Ergot ; hydrastis ; hydrastinine hydrochlorate ; gossypii radicis 
cortex, and quinine. 

ERGOTA— ERGOT. 

What is ergot ? 

Ergot is the schrotium of Claviceps purpurea [Nat. Ord. Fungi), 
replacing the grain of Secale cereale [Nat. Ord. Graminaceae), or, 
in other words, it is a fungus growing from the diseased ovary of 
rye. ' ' When more than a year old it is unfit for use. ' ' 



OXYTOCICS — ERGOT. 171 

What does it contain ? 

The exact chemical composition of ergot is still a matter of doubt, 
but the latest researches seem to show that it contains a resinoid sub- 
stance, sphacelinic acid, and a neutral principle, cornutin, which 
together represent the value of the drag. 

What are its physiological effects ? 

The effects of ergot are chiefly manifested on the uterus of the 
pregnant female and on the circulation. In the non-pregnant, small 
doses produce no perceptible effect ; moderate doses slow the heart, 
probably by stimulating the peripheral fibres of the vagi, and enor- 
mously increase the blood pressure by stimulating the vaso-motor 
centres. Large doses cause nausea and vomiting, increased peri- 
stalsis and purging. Toxic doses depress the heart by acting directly 
on its muscle or contained ganglia, and lower the blood-pressure, 
partly by its action on the heart and partly from depression of the 
vaso-motor centres. 

When poisonous doses are given to animals, there is salivation, 
vomiting and sometimes diarrhoea, rapid pulse and respiration, dilated 
pupil, trembling, great thirst, prostration, paraplegia, convulsions 
and death. The nervous symptoms appear to be due to action on 
the nerve centres. 

Ergot possesses the property of causing contraction of all non- 
striated muscular fibres: thus it contracts the arterioles, increases 
intestinal peristalsis, and increases the power as well as the duration 
of the uterine contractions during labor, but does not always origi- 
nate them during pregnancy or at other times, except immediately 
prior to and after parturition. 

What is ergotism ? 

When ergot is used continuously in large amounts as an article of 
diet, it produces a condition of chronic poisoning, which manifests 
itself either by gangrene (usually dry, but occasionally moist and 
attended with septicaemia) or by tetanic spasms. 

What are the medicinal uses of ergot ? 

Ergot is used as an oxytocic in small doses in uterine inertia during 
the second stage of labor, when there is no resistance either on the 
part of the bony canal or the soft parts of the mother. When thus 
administered, it energizes the uterine contractions, but if given in 



172 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

large doses it renders them tetanic and continuous, thus greatly 
increasing the danger both to the mother and child. 

To prevent post-partum hemorrhage by contracting the uterus, 
and thus compressing the uterine sinuses, it is invaluable, but had 
better be withheld until the placenta has left the uterine cavity, as 
prior to this it will tend to imprison the placenta by contracting the 
cervix. After the uterus is empty, it may be given in full doses, 
either by the mouth or hypodermically. 

It has been used to induce premature labor, but is at best an 
uncertain remedy for this purpose. To arrest hemorrhage in cases 
of tlweatened abortion, ergot is worse than useless, unless the uterus 
is emptied. In these cases, by contracting the cervix, it imprisons 
the ovum, and thus, by preventing its escape, keeps the uterus dis- 
tended. If given at all in these cases, its administration should be 
conjoined with the application of vaginal tampons. It is also given 
to aid the expulsion of uterine polypi. 

As a haemostatic, it is used in all hemorrhages where surgical 
means of arrest cannot be employed, and is often given as an adju- 
vant to their local treatment. In menorrhagia, epistaxis, hemorrhage 
from the gums, and in broncho-pulmonary, intestinal or renal hem- 
orrhage it is very efficient. In hcematemesis, it is not so serviceable. 
In purpura, it acts beneficially. From its influence in contracting 
blood vessels, it has been used in the early stages of pneumonia and 
other inflammatory affections, in spinal congestions, in cerebrospinal 
meningitis, and for the cure of internal aneurisms. It has been 
injected hypodermically near the seat of disease for the cure of 
varices, hemorrhoids, and impotence due to dilatation of the dorsal 
vein of the penis. It may be employed with great advantage, either 
internally or hypodermically, to reduce the size of an enlarged spleen. 
In glycosuria and in polyuria it does good, and, from its influence 
on unstriped muscular fibres generally, it is useful in relaxation of the 
sphincters, diarrhoea, dysentery, spermatorrhoea, uterine subinvolu- 
tion, and to diminish the size of subperitoneal uterine fibroids. 

What are the preparations of ergot and their doses ? 

Extractum Ergots {extract of ergot) is five times as strong as 
the fluid extract ; dose gr. v-xv (0.3-1.0). It may be used hypoder- 
mically, dissolved in water and filtered. 



OXYTOCICS— BARK OF COTTON ROOT. 173 

Extractum Ergots Fluidum {fluid extract of ergot), dose 
n[v-f3iv (0.3-15.0). 

Vinum Ergot^e {wine of ergot) contains 15 per cent, of powdered 
ergot; dose f3j-iv (4.0-15.0). 

HYDRASTIS. 

What is hydrastis ? 

Hydrastis is the rhizome and roots of H. canadensis, yellow root 
or golden seal {Nat Ord. Ranunculaceas). It has been already 
considered under the Bitter Tonics {q. v.). 

HYDRASTIN^ HYDROCHLORAS — HYDRASTINE HYDROCHLORATE. 

What is this substance ? 

It is the hydrochlorate of an artificial alkaloid produced by the 
oxidation of hydrastine, and has been found to produce powerful 
uterine contractions, stimulating also the muscular fibres of the 
heart, arterioles, and intestines. It probably stimulates the volun- 
tary muscles, but in a lesser degree. 

In fatal doses it depresses powerfully the entire motor nervous 
tract and causes death by respiratory failure. 

It has been used with success in menorrhagia and metrorrhagia 
and other uterine hemorrhages. 

It is also recommended as a heart tonic. Dose gr. £-j (0.016- 
0.065). 

GOSSYPII RADICIS CORTEX — BARK OF COTTON ROOT. 

What is gossypii radicis cortex ? 

It is the bark of the root of Gossypiurn herbaceum and other spe- 
cies of Gossypium {Nat. Ord. Malvaceae). 

Given to animals, it first slows and then quickens the cardiac action, 
which is always enfeebled by first stimulating and then paralyzing 
the cardio-inhibitory apparatus and depressing the cardio-motor gan- 
glia. It stimulates and then depresses the vaso-motor centres, causing 
a rise, but subsequently a fall, in the blood pressure. It stimulates 
non-striated muscular fibres, and appears to excite rhythmical con- 
tractions of the gravid uterus and to increase their power when 
present. It depresses the reflex centres of the cord, and causes 



174 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

death by respiratory paralysis, generally preceded by convulsions, 
which are not of cerebral origin. 

It has been recommended as a substitute for ergot in uterine inertia, 
postpartum hemorrhage, and to aid the expulsion of uterine myo- 
mata. It has been used in chonic metritis, and although not as 
efficient as ergot, is useful in menorrhagia. 

Extractum GossYPii Radicis Fluidum {fluid extract of cotton 
root), dosef3ss-j (2.0-4.0). 

QUININA — QUININE. 

Is quinine oxytocic ? 

Although quinine is used for this purpose, it probably posseses no 
action on the uterus per se, but as an antiperiodic or as a tonic, is 
capable of overcoming the morbid conditions (as malaria) which, by 
depressing the system at large, may prevent normal, healthy uterine 
contractions. 



ORDER IV. — Uterine Sedatives. 
What are uterine sedatives ? 

They are medicines which are employed to depress the uterine mus- 
cular or nervous apparatus and restrain violent, irregular or untimely 
uterine contractions. 

What medicines are used for this purpose, and when are they 
employed ? 

They are principally useful during pregnancy, to prevent abortion 
which is threatening, but not inevitable. They are also of service in 
arresting the irregular uterine contractions which sometimes occur 
prior to labor, and are called "false labor pains." For the former 
purpose opium, cannabis indica and the motor depressants — as 
chloral, the bromides, tartar emetic and viburnum prunifolium, 
especially the first- and last-named remedies — are used, while for 
the latter opium and chloral are employed. To moderate too 
violent contractions during labor, ether is the best remedy. Of 
these medicines all have been described except 



UTERINE SEDATIVES— VIBURNUM PRUNIFOLIUM. 175 

VIBURNUM PRUNIFOLIUM. 

What is viburnum prunifolium ? 

It is the baric of V. prunifolium, sloe or black haw (Nat. Ord. 
Caprifoliaceae), a small indigenous tree. It contains valerianic acid, 
a bitter principle [viburnin), resin, tannin, etc. Its physiological 
effects are not understood. It appears to diminish reflex irritability 
and to have a sedative effect on involuntary muscular fibre and pos- 
sibly lowers blood-pressure. Toxic effects are only seen after 
enormous doses have been administered, and consist of headache, 
dryness of the mouth and throat, and disordered vision. 

It has been employed as a uterine sedative in habitual and in 
threatened abortion, in congestive and neuralgic dysmenorrhoea, in 
menorrhagias and in nervous disturbances occurring at the climacteric 
period, in post-partum dolores when no clots or fragments of the 
placenta remain in the uterus, and in false labor-pains. It has also 
been used in colicky diarrhoea and dysentery, and is even recom- 
mended for cramps occurring in the voluntary muscles. 

Extractum Viburni Fluidum [fluid extract of viburnum) , dose 
f3ss-ij (2.0-8.0) in elixir of orange. 



ORDER Y.— Emmenagogues. 
What are emmenagogues ? 

Emmenagogues are medicines employed to increase or reestablish 
the menstrual flow when it is scanty or suppressed from other causes 
than pregnancy or the climacteric period. 

When the catamenia are arrested from pregnancy, medicines used 
to bring them on cannot but be injurious to the woman, as the doses 
necessaiy are sufficient to cause poisoning, one of the symptoms of 
which may (or may not) be uterine hemorrhage. This is especially 
true of cantharides and of the volatile oils. 

What medicines are used as emmenagogues ? 

When amenorrhoea depends upon anaemia or chlorosis the best 
emmenagogues are iron (combined with aloes or myrrh), arsenic or 
manganese. When local anaemia or an atonic condition of the 
uterus is present, aloes [q. v.) is very useful. If, on the other hand, 
pelvic plethora exists with constipation and a scanty flow often of a 



176 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

thick black discharge accompanied with pelvic pain and fullness, the 
saline cathartics are employed. 

In suppression of the menses from cold, aloes and potassium 
permanganate are usually more successful. In amenorrhoea due to 
an atonic condition of the uterus, the more stimulating emmena- 
gogues are given, generally with aloetic purgatives. 

STIMULATING EMMENAGOGUES. 

Name the stimulating emmenagogues. 

Savine, tansy, apiol, cantharides and guaiac. 

SABINA — SAVINE. 

What is savine ? 

Savine is the tops of Juniperus Sabina (Nat. Ord. Coniferse), a 
small evergreen shrub of Southern Europe. It contains a volatile 
oil. When applied locally savine is irritant. In medicinal doses it 
increases the circulation, is a gastric, uterine and renal irritant, and 
proves diuretic. In overdoses it is a gastro-intestinal irritant with 
great depression, unconsciousness, convulsions, hemorrhages from 
the uterus and kidneys, suppression of urine and, in pregnant 
females, abortion. Death occurs from collapse. Savine is used in 
relaxed states of the uterus and uterine vessels, and has proved 
successful in the treatment both of amenorrhoea and menorrhagia 
when due to atonic condition of this organ. 

Extractum Sabine Fluidum (fluid extract of savine), dose 
nuv-x (0.3-0.6). 

Oleum Sabin^e (oil of savine), the best preparation for internal 
use; dose gtt. v-x (0.3-0.6), in capsules or emulsion, every 3 or 4 
hours. 

TANACETUM — TANSY. 

What is tansy ? 

Tansy is the leaves and tops of Tanacetum vulgare {Nat. Ord- 
Compositse). It contains a volatile oil and a bitter principle (tan- 
acetin). It is a gastro-intestinal irritant and diuretic, and in large 
doses causes death from respiratory paralysis, preceded by epilepti- 
form convulsions of cerebral origin, and unconsciousness. It is used 
as a stimulating emmenagogue, but is a very dangerous remedy. 
The minimum fatal quantity is unknown. Dose gr. x-xxv (0.6-1.5), 
in infusion ; of the oil, n\J (0.06) may be given. 



EMETICS. 177 

APIOL. 

What is apiol ? 

Aptol (not official), or parsley-camphor, is obtained from the vol- 
atile oil of the root of Petroselinum sativum (Nat. Orel. Umbelli- 
ferae). It is very efficacious as a stimulating emmenagogue m func- 
tional and anaemic amenorrhoea and in neuralgic dysmenorrhea, 
but is contraindicated in any condition of plethora. Dose gtt. iij-x 
(0.18-0.6) in gelatin capsules given morning and evening for 4 or 5 
days before the expected menstrual period. 

The French capsules or pearls usually contain gr. iij^j (0.25) of 
apiol. 

CANTHARIDES — GUAIAC. 

What are these substances ? 

Canikarides will be considered under "Irritants." The tincture 
is used as a stimulating emmenagogue, dose nUij-v (0.18-0.3), t. i. d., 
great care being taken to avoid strangury. 

Guaiac has been considered with the " Alteratives." 



(D) ON THE ALIMENTARY CANAL. 

ORDER I.— Emetics. 
What are emetics, and how do they act? 

Emetics are medicines which are given to induce vomiting. They 
may act either by directly irritating the stomach, thus causing 
expulsion of its contents in a reflex manner, when they are called 
local emetics, or by acting, after absorption, on the reflex centre of 
the medulla which governs emesis, when they are called systemic 
emetics. It does not always follow that a remedy is a systemic 
emetic because it causes vomiting when given hypodermically or per 
rectum, for it may be eliminated by, and produce irritation of, the 
gastric mucous membrane, thus exciting reflex vomiting. 

For what purposes are emetics used? 

Emetics are used (1 ) to unload the stomach ; (2) to depress the 
circulatory system by inducing nausea (as in the early stages of 
bronchitis or of tonsillitis, in which emetics, frequently repeated in 
12 



178 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

small doses, will sometimes arrest trie inflammation) ; (3) to relax 
the muscular system and relieve spasm (as in spasmodic croup) ; (4) 
to promote secretion and excretion ; (5) to expel foreign bodies or 
secretions from the air passages, and (6) as revulsives. 

What are the contraindications to their employment ? 

They should never be employed in cases of cerebral or gastric in- 
flammation, and should be used cautiously, if at all, in the latter 
stages of pregnancy, in hernia, or where great depression exists, as 
in the latter stages of capillary bronchitis or of croup. 

Name the medicines employed as emetics. 

The vegetable emetics are ipecac, apomorphine and mustard. The 
mineral emetics are zinc sulphate, copper sulphate, alum, turpeth 
mineral and tartar emetic. 



IPECACUANHA — IPECAC. 

What is ipecac, and what chemical principles does it contain? 

Ipecac is the root of Cephaelis Ipecacuanha (Nat. Ord, Rubiaceae), 
a plant of Brazil. Its effects depend upon an alkaloid, emetine, 
which is combined with ipecacuanhic acid. 

What are its physiological actions ? 

Locally applied, ipecac is an irritant, either to the skin or 
mucous membranes. Given internally in small doses, repeated, it 
increases the perspiration, saliva, bile, the secretions from the 
broncho-pulmonary and gastro -intestinal mucous membranes, and 
causes nausea. In sufficient amounts it greatly augments the secre- 
tions and induces vomiting, without much nausea or depression, no 
matter how exhibited, emesis being more rapid when it is taken by 
the mouth. 

Toxic doses in animals depress the respiration and paralyze the 
heart directly. Post-mortem examination shows the mucous mem- 
branes of the stomach, intestines and lungs to be intensely con- 
gested. Sometimes, however, the lungs are almost exsanguine. 

What are the medicinal uses of ipecac ? 

Ipecac is employed as an emetic, and is the safest remedy which 
can be given for this purpose, especially to children. It is particu- 



EMETICS— IPECAC. 179 

larly of service when it is desired to evacuate the contents of an 
overloaded stomach without producing much depression, as an adjunct 
to other remedies in croup and in the earlier stages of capillary 
bronchitis. In narcotic poisoning it is not as efficient as the mineral 
emetics. 

As an expectorant it is added to cough medicines in the dry stage 
of bronchitis. As a cholagogue it is a valuable addition to purga- 
tive pills. As a haemostatic it is highly recommended in haemoptysis 
and post-partum hemorrhage. 

In the treatment of dysentery, especially when epidemic, it is of 
great service, given in large dose (gr. xx-£ij (1.28-8.0), every few 
hours). When thus administered a tolerance is soon established, 
and no nausea or vomiting is produced. It is also useful in various 
kinds of diarrhoea, especially of choleriform and tuberculous diar- 
rhoea. Reflex vomiting, as the vomiting of pregnancy, has some- 
times been arrested by minute doses of the wine of ipecac. 

What are the preparations of ipecac and their doses ? 

Ipecac may be given in powder, dose as an emetic gr. x-xx (0.64- 
1.28); as a nauseant, gr. ss-ij (0.03-0.13); as an expectorant and 
diaphoretic, gr. \-% (0.016-0.032) ; as a stomachic tonic and hepatic 
stimulant, gr. ^-J- (0.005-0.008). 

Extractum Ipecacuanha Fluidum {fluid extract of ipecac), 
dose as an emetic Ttlxx-xxx (1.23-1.8), repeated until vomiting occurs. 

Vinum Ipecacuanha {wine of ipecac) contains 10 per cent, of 
the fluid extract; dose as emetic f3j-iv (4.0-16.0). 

Syrupus Ipecacuanha {syrup of ipecac) contains 7 per cent. 
of the fluid extract; as an emetic f3j-ij (4.0-8.0) may be given to 
a child, or n\,v-x (0.3-0.6) as an expectorant. 

Trochisci Ipecacuanha {troches of ipecac), each contains about 
gr. £ (0.02) of ipecac. 

Powder of ipecac and opium (Dover's powder), tincture of ipecac 
and opium, and troches of ipecac and morphine have been consid- 
ered under "Opium." 

APOMORPHINA HYDROCHLORAS — APOMORPHINE HYDROCHLORATE. 

What is apomorphine hydrochlorate ? 

It is the hydrochlorate of an artificial alkaloid obtained from 
morphine or codeine. 



180 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

What are its physiological actions ? 

Griven to warm-blooded animals in small doses it causes vomiting ; 
after large doses there is salivation, violent vomiting and muscular 
tremors ; toxic doses induce great restlessness, paresis, convulsions, 
hurried respiration and death from asphyxia, without the occurrence 
of emesis. 

It is a systemic emetic, probably in medicinal doses stimulating 
the reflex centre for vomiting, but in large doses depressing and 
paralyzing it. No matter how administered, emesis takes place 
promptly, with but little nausea and rarely accompanied by much de- 
pression. Large doses appear to stimulate and finally paralyze the 
respiratory centre. It increases the pulse-rate by stimulating the 
accelerator fibres (?), and in large doses by stimulating the vaso- 
motor centres, it raises the arterial pressure. In toxic doses it de- 
presses the cardiac muscle and thus reduces the blood pressure. In 
large doses it is at first a cerebral stimulant, but later depresses and 
paralyzes the brain. The cause of the convulsion is not understood. 
It is a muscle poison. 

What are the uses and doses of apomorphine hydrochlorate ? 

It may be employed as an emetic whenever prompt evacuation of 
the stomach is required, and may be administered either hypodermi- 
cally or by the mouth. In narcotic poisoning it is highly recom- 
mended. 

As an expectorant in the early stages of acute bronchitis or in 
chronic bronchitis without much expectoration, it is very serviceable, 
and can be advantageously used in capillaiy bronchitis of children 
both as an expectorant and emetic. The adult dose as an emetic is 
gr. tV (0.004) hypodermically, or gr. ^-i (0.005-0.008) by the 
mouth. As as expectorant smaller doses are required. 

SINAPIS — MUSTARD. 

What is mustard, and how is it used as an emetic ? 

Mustard is the seed of Brassica nigra and B. alba (Nat- Ord. 
Cruciferse). Mustard flour is irritant to the mucous membranes as 
well as to the skin, and is a prompt and efficient local emetic, espe- 
cially useful when torpor of the stomach is present. It will be more 
fully considered hereafter. Dose as an emetic from a teaspoonful to 



GASTRIC SEDATIVES. 181 

a tablespoonful (4.0-16.0) of the flour, in a glass of tepid water, 
repeated, if necessary, in 1 5 or 20 minutes. 

What mineral emetics are employed ? 

Zinci Sulphas [zinc sulphate) is a prompt and efficient local 
emetic. Dose gr. x-xx (0.6-1.2), or even gr. xxx (1.9) in narcotic 
poisoning. 

Cupri Sulphas {copper sulphate) is a prompt local emetic, but 
more irritating than the zinc salt. Dose gr. iij-v (0.10-0.3) or even 
gr. x (0.6) in narcotic poisoning. It is the best emetic in poisoning 
by phosphorus (q. v.). 

Alumen (alum) is also a local emetic of value, especially useful 
in membranous croup, and useful also in capillary bronchitis ; dose 
a teaspoonful (4.0) of the powdered drug in molasses, or, better, in 
syrup of ipecac. 

Hydrargyri Subsulphas Flavus (yellow mercurial subsul- 
phate — Turpeth mineral), used as an emetic in croup ; dose gr. j-v 
(0.06-0.3) repeated every 10 or 15 minutes until free vomiting occurs. 

Antimonii et Potassh Tartras (antimonium and potassium 
tartrate — tartar emetic) is rarely used as an emetic because of the 
great depression which it induces; dose gr. j-ij (0.06-0.13). 

Of these substances the three first will be found under the head 
of astringents, while the two last have already been considered. 



ORDER II.— Gastric Sedatives. 
What are gastric sedatives ? 

They are medicines employed to diminish gastric irritability, and 
thus allay nausea and vomiting. 

What medicines are nsed for this purpose ? 

When vomiting is due to acute irritation, as from an overloaded 
stomach, the ingestion of acrid substances, or cholera morbus, it is 
best treated, after the contents have been evacuated, by minute doses 
of calomel (gr. T *o (0.005)) with sodium bicarbonate (gr. j (0.06)); 
pellets of ice dissolved in the mouth ; lime-water and rest. A small 
dose of brandy will sometimes kt settle the stomach." If irritability 
persists, small doses of morphine, or of diluted hydrocyanic acid or 



182 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

creasote, or bismuth and sodium bicarbonate answer better. When 
due to the formation of gases from fermentation, creasote, carbolic 
acid, thymol, sulphurous acid, the sulphites or charcoal are given. 

When vomiting occurs on taking food after long abstinence, and 
perhaps preceding irritation, calomel and sodium bicarbonate in 
minute amounts, followed by small doses of brandy, and milk and 
lime-water by the teaspoonful (4.0) at intervals, should be employed. 
Ether-vomiting is best met with teaspoonful (4.0) doses of very hot 
water given every 10 or 15 minutes. Reflex vomiting, as of sea- 
sickness or of pregnancy, usually requires a medicine which will 
depress the centre in the medulla presiding over the act, as opium, 
the bromides, or diluted hydrocyanic acid. Among other remedies 
used for the latter variety of vomiting may be mentioned, tincture 
of nux vomica (gtt. J-j (0.015-0.06), cerium oxalate (gr. J-v (0.016- 
0.3)), wine of ipecac (gtt. \-\] (0.015-0.12)), and Fowler's solution 
(fflr-j (0.015-0.06)). Counter-irritation over the epigastrium often 
aids the action of gastric sedatives. The above remedies have already 
been noticed or will be discussed in their appropriate places. 



ORDER III.— Carminatives. 
What are carminatives ? 

Carminatives are medicines employed to aid the expulsion of gases 
from the stomach and intestines. 

What medicines are used as carminatives ? 

The aromatics, which owe their virtues principally to the volatile 
oil which they contain, are especially used for this purpose. Other 
drugs containing volatile oils, as asafetida, eucalyptus, etc. , are also 
carminative ; and ether is sometimes employed for the same object. 

What are the general effects of the aromatics ? 

Locally they are irritant and rubefacient. The oils are also local 
anaesthetics. Internally in medicinal doses they are gastric and 
intestinal stimulants, increasing peristalsis and temporarily increasing 
to a slight extent the force and frequency of the pulse. In larger 
doses they stimulate the brain and cause a species of intoxication. 
In very large doses they are irritant and narcotic poisons. 



CARMINATIVES. 183 

What are their medicinal uses ? 

The aroniatics are used internally as carminatives ; to prevent the 
griping of purgatives ; to correct the unpleasant taste or smell of 
other medicines, and as gastric stimulants. 

Locally they are employed as rubefacients, antiseptics and ano- 
dynes. They should never be used when inflammation of the stomach 
or bowels is present, but in diarrhoea due to relaxation they are often 
of service. 

Name the aromatics, their chemical constituents, prepara- 
tions and doses. 

Capsicum, or red pepper, is the fruit of C. fastigiatum (Nat. 
Ord. Solanaceae). It contains a resin, a. fixed and a volatile oil. It 
is used as a condiment, as a gastric stimulant, particularly in the 
case of drunkards, as an addendum to tonic pills, as a carminative 
in cases of feeble digestion, as a gargle in tonsillitis, and externally 
as a rubefacient. 

Extractum Capsici Fluidum [fluid extract of capsicum), dose 
ttvv-x (0.3-0.6). 

Tinctura Capsici (tincture of capsicum), dose Tr\,v-f3j (0.3-4.0). 

Oleoresina Capsici (oleoresin of capsicum), dose gr. ss-j (0.03- 
0.06). 

Emplastrum Capsici {plaster of capsicum), for external use. 

Piper (pepper) is the unripe fruit of Piper nigrum (Nat Ord. 
Piperacefe). It contains a volatile oil, an acrid resin and a neutral 
principle, piperin, which increases the respiration and circulation, 
dilates the pupil, and finally paralyzes the heart in systole. It has 
been used as an antiperiodic. Pepper is used as a condiment and 
sometimes as a stomachic stimulant, combined with other medicines, 
in atonic dyspepsia, and as a carminative. 

Oleoresina Piperis (oleoresin of pepper), dose gr. ss-ij (0.03- 
0.13). 

Piperinum (piperin), dose gr. j-v (0.06-0.3). 

ClNNAMOMDM Cassia (cassia cinnamon), the bark of the shoots 
of one or more undetermined species of cinnamomum. grown in 
China (Nat. Ord. Laurineae) ; Cinnamomum Saigonicum (Saigon 
cinnamon), the bark of an undetermined species of cinnamomum 



184 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

(Nat. Ord. Laurineae) (which comes from Cochin-China) ; and Cin- 
NAMOMUM Zeylanicum (Ceylon cinnamon), the inner bark of the 
shoots of cinnamomnm Zeylanicum {Nat. Ord. Laurineae), are all 
recognized by the Pharmacopoeia. Of these varieties the latter is 
considered the finest and the former the poorest in quality. They 
contain volatile oil, tannic acid, etc. , are slightly astringent, and are 
used as carminatives, flavonng ingredients, and vehicles. 

TlNCTURA Cinnamomi {tincture of cinnamon) contains 10 per cent, 
of powdered Ceylon cinnamon; dose f3j-ij (4.0-8.0). 

Aqua Cinnamomi {cinnamon water) contains 0.2 per cent, of the 
oil of cinnamon, and is used as a vehicle. 

Oleum Cinnamomi (oil of cinnamon) is a volatile oil distilled 
from cassia cinnamon ; dose gtt. j-iij (0.06-0.18). 

Spiritus Cinnamomi (spirit of cinnamon) contains 10 per cent, 
of the oil; dose l^x-xxx (0.6-2.0). 

Myristica (nutmeg); Macis (mace). These are parts of the 
fruit of Myristica fragrans (Nat. Ord. Myristicaceae), the arillode 
of the seed being mace, and the seed nutmegs. Both contain vola- 
tile oils. They are aromatic stimulants, carminatives, and in large 
doses narcotics. 

Oleum Myristica (oil of nvtmeg), dose gtt. j-v (0.06-0.3). 

Spiritus Myristic^e (spirit of nutmeg) contains 5 per cent, of 
the oil; dose f3ss-ij (1.8-7.3). 

Caryophyllus (cloves) is the vn expanded flowers of Eugenia 
aromatica {Nat. Ord. Myrtaceae). They contain volatile oil, tannic 
acid, caryopliyllin and en gen in. They are gastric stimulants and 
carminatives, but are principally employed as a condiment. The 
oil is used as a local anodyne to carious teeth. 

Oleum Caryophylli (oil of cloves), dose gtt. iij-v (0.18-0.3). 

Pimenta, or allspice, is the nearly ripe fruit of Pimenta officinalis 
{Nat. Ord. Myrtaceae). It contains a volatile oil, and is carminative. 
Oleum Pimento (oil of pimenta), dose gtt. iij-v (0.18-0.3). 

Zingiber (giuger) is the rhizome of Z. officinale (Nat. Ord. 
Scitamineae). It contains a volatile oil and an acrid resin. It is a 



CARMINATIVES. 185 

gastric stimulant and carminative, much employed in flatulency and 
colic and as an addition to other stomachics. 

Extractum ZlNGlBERlS Fluidum {fluid extract of ginger), dose 
ttu-xxx (0.6-2.0). 

Tinctura Zingiberis {tincture of ginger), dose f3ss-j (2.0-4.0). 

Syrupus Zingiberis [syrup of ginger), used as a vehicle for 
other medicines. 

Oleoresina Zingiberis {oleoresin of ginger), used as a correc- 
tive to purgative pills to prevent griping; dose i^lss-ij (0.03-0.12). 

Trochisci Zingiberis {troches of ginger), dose 2 or 3 lozenges. 

Cardamomum {cardamom) is the fruit of Elettaria repens [Nat. 
Ord. Scitamineae), and contains a volatile oil. It is used as a gastric 
stimulant and carminative, and as an adjuvant and corrective of 
other medicines. 

Tinctura Cardamomi {tincture of cardamom), dose f£>j-ij 
(4.0-8.0). 

Tinctura Cardamomi Composita {compound tincture of carda- 
mom) contains also caraway, cassia, cinnamon, and cochineal ; dose 
fSJ-ij (4.0-8.0). 

Pulyis Aromaticus {aromatic poioder) consists of ceylon cinna- 
mon and ginger (35 per cent, each), with cardamom and nutmeg 
(15 per cent, each). An excellent carminative preparation. Dose 
gr. x-xxx f 0.6-2.0). 

Extractum Aromaticum Fluidum {aromatic fluid extract) is a 
fluid extract of aromatic powder. Dose tt\,xv-xxx (1.0-2.0). 

Oleum Cajuputi {oil of cajuput) is the volatile oil distilled from 
the leaves of Melaleuca Leucadendron {Nat. Ord. Myrtacese), and 
is very destructive to low organisms. It has been employed as 
a remedy against ascarides and, locally, in parasitic skin diseases, 
but is chiefly used as a gastric stimulant and carminative in flatulent 
colic and to prevent the griping of cathartics. Dose mj-v (0.06- 
0.3). 

Calamus is the rhizome of Acorus Calamus {Nat. Ord. Aroideae). 
It contains a volatile oil and a glucoside, acorin. It is an aromatic 
stimulant and is somewhat tonic. 

Extractum Calami Fluidum {fluid extract of calamus), dose 
KU-xxx (0.6-2.0). 



186 ESSENTIALS OF MATERIA MEDlCA AND THERAPEUTICS. 

Oleum Gaultheria (oil of gaultheria) is a volatile oil distilled 
from the leaves of G. procumbens or wintergreen [Nat Ord. Erica- 
ceae), and has been considered under the head of " Salicylic Acid ". 
It consists almost entirely of methyl salicylate and is nearly identical 
with volatile oil of Betula (vid. Salicylates) ; dose in rheumatism 
ttLv-xv (0.31-0.93 c. c). 

Spiritus Gaultheria [spirit of gaultheria) contains 5 per cent, 
of the oil; dose HLx-xxx (0.62-1.85 c. c). 

The following herbs, belonging to the Nat Ord. Labiatse, con- 
tain volatile oils, and are used as carminatives, gastric stimulants 
and flavoring ingredients: — 

Oleum Lavendula Florum (oil of lavender flowers) is a volatile 
oil distilled from the flowers of L. vera. Dose gtt. j-v (0.06-0.3). 
Spiritus Lavendulce [spirit of lavender) and Twctura Lavendulce 
Composita (compound tincture of lavender) are also official; dose 
of either f3ss-j (2.0-4.0). 

Mentha Piperita [peppermint) and Mentha Viridis [spear- 
mint). The leaves and tops are official. The oils [oleum menthce 
piperita? and oleum menthce viridis, dose gtt. j-v (0.06-0.3)) are 
usually given in the form of spirit (spiritus menthce piperitce and 
spiritus menthce viridis), dose ttLv-xxx (0.3-2.0). The waters [aqua 
menthce piperitce and aqua menthce viridis) are used as vehicles. 
Troches of peppermint [trochisci menthce piperita?) are sometimes 
used in flatulent colic. 

Oleum Rosmarini [oil of rosemary) is a volatile oil distilled from 
the leaves of Rosmarinus officinalis. It is carminative, but is 
chiefly used as an ingredient of rubefacient liniments. 

Hedeoma (pennyroyal). The leaves and tops of H. pulegioides 
are official. The volatile oil (oleum hedeomce) may be given in doses 
of mj-v (0.06-0.3). 

Marrubium (horehound). The leaves and tops of M. vulgare are 
used as a gastric stimulant and expectorant. 

Salvia (sage). The leaves of S. officinalis are slightly astringent 
as well as aromatic. An infusion is sometimes used as a gargle in 
sore throat. 

Oleum Thymi (oil of thyme), a volatile oil distilled from the 
leaves and flowering tops of Thymus vulgaris, contains much thymol 



CARMINATIVES. 187 

[q. v.), and is therefore not only aromatic and carminative, but anti- 
septic and antifermentative. 

The following seed are derived from plants belonging to the Nat. 
Ord. Uinbelliferge : — 

F(ENICULUM {fennel), from F. capillaceum. Of the oil {oleum 
fceniculi), the dose is gtt. v-x (0.3-0.6). A water {aqua fceniculi) 
is also official. 

Carum {caraway), from C. Carvi. Dose of the oil {oleum can) 
gtt. j-x (0.06-0.6). 

Anisum {anise), from Pimpinella anisum. Dose of the oil {oleum 
anisi) gtt. v-xv (0.3-0.9). A spirit {spiritus anisi) and a water 
{aqua anisi) are also official. 

Coriandrum {coriander), from C. sativum. The oil {oleum 
coriandri) is official. 

Illicium {star-anise) is the fruit of I. verum [Nat. Ord. Mag- 
noliacese). It contains a volatile oil, and is used as a substitute for 
anise. 

The following preparations are only used as flavors and vehicles : — 
Aurantii Amari Cortex {bitter orange peel) ; Aurantii Dul- 
cis Cortex {sweet orange peel). These are respectively the rind 
of the fruits of Citrus vulgaris (bitter orange) and of C. Aurantium 
(sweet orange) {Nat. Ord. Rutacese). The following preparations 
are official : — 

Oil of orange flowers, or oil of neroli [oleum aurantii florum), a 
volatile oil distilled from the fresh flowers of the bitter orange; 
stronger orange flower water {aqua aurantii florum fortior — aqua 
aurantii florfim, Pharm. 1880 — triple orange floive?' ivater), water 
saturated with the volatile oil of fresh orange flowers, obtained as a 
by-product in the distillation of the oil of orange flowers ; orange 
flower water {aqua aurantii florUm), equal volumes of stronger 
orange flower water and distilled water freshly mixed ; syrup of 
orange flowers {syrupus aurantii florum); syrup of orange peel 
{syrupus aurantii); oil of orange peel {oleum aurantii corticis) ; 
spirit of orange [spiritus aurantii); compound spirit of orange 
{spiritus aurantii compositus) contains oil of orange peel (200), oil 



188 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

of lemon (50), oil of coriander (20), and oil of anise (5) in 1000 parts 
of the preparation. It is used in making elixir aromaticum (aro- 
matic elixir), which contains 12 parts of the compound spirit in 
1000 parts of the preparation ; fluid extract of bitter orange peel 
[extraction aurantii amari flnidum) ; tinctures of bitter and of sweet 
orange peel (tinctura aurantii amari, tinctura aurantii dulcis) — dose 
of either tincture, f3j-ij (4.0-8.0). 

Vanilla, the fruit of V. planifolia {Nat. Ord, Orchidacese), con- 
tains vanillin. The tincture (tinctura vanilla?) is official. 

The oil of turpentine is an excellent carminative and will be con- 
sidered hereafter. 



ORDER IV.— Cathartics. 
What are cathartics? 

Cathartics are medicines employed to produce an evacuation from 
the bowels either by increasing intestinal peristalsis, or by increasing 
the secretions of the canal and its appendages. 

For what purposes are they used ? 

They are used (1) to unload the bowels ; (2) to deplete the blood 
vessels by abstracting water from the blood ; (3) to promote absorp- 
tion ; (4) to stimulate secretion ; (5) to eliminate noxious material 
from the blood (as the poison of uraemia) ; (6) to act as revulsives, and 
(7) to influence the pelvic circulation. 

How may cathartics be classified ? 

Cathartics are divided into laxatives, simple purgatives, salines 
and drastics. 

Laxatives. 
What are laxatives ? 

Laxatives are such substances as unload the bowels, acting with- 
out irritation and not causing purgation. 

Name the laxatives. 

Tamarind, manna, cassia fistula, frangula, cascara sagrada, castor 
oil, sulphur and sulphurated potassa. 



CATHARTICS— CASTOR OIL. 189 

TAMARINDUS — TAMARIND. MANNA. VIOLA TRICOLOR. 

What are these substances ? 

Tamarindus {tamarind) is the preserved pulp of the fruit of T. 
indica {Nat. Ord. Leguminosse), a tree of India. Eaten as a pre- 
serve (^ss-j (15.0-31.0)) it is laxative. An infusion makes a pleasant 
refrigerant drink. It enters into confection of senna. 

Manna is the concrete saccharine exudation of Fraxinus Ornus 
(Nat. Ord. Oleacese). It contains mannit, fraxiii, and resin 
which is probably the laxative principle. Manna is usually com- 
bined with other cathartics. Dose for an adult ^j-ij (31.0-62.0) ; 
for children, 3j-iv (4.0-15.0). 

CASSIA FISTULA. FRANGULA. RHAMNUS PURSHIANA. 

What are these substances ? 

Cassia Fistula is the fruit of C. Fistula or purging cassia (Nat. 
Ord, Leguminosae). It is an ingredient of the confection of senna. 
Dose 3J-3J (4.0-31.0). 

Frangula is the bark of Rhamnus Frangula or alder buckthorn 
(Nat. Ord. Rhamneae). It contains frangulin and emodiu, and as 
it is an active emetic and hydragogue when fresh, it should be kept 
a year at least before being used ; dose of the fluid extract (extractum 
frangula^ fluidum) f^ss-j (2.0-4.0). 

Rhamnus Purshiana (cascara sagrada or chittem bark) is the 
bark of R. Purshiana (A T at. Ord, Rhainnaceae), a tree of California. 
It contains several resins and is an efficient laxative, very useful in 
habitual constipation ; dose of the fluid extract (extractum rhamni 
purshiana fluidum) tt\,x-f3j (0.6-4.0). 



OLEUM RICINI — CASTOR OIL. 

What is castor oil? 

It is a fixed oil expressed from the seed of Ricinus communis, or 
Palmi Christi (Nat. Ord, Euphorbiaceae). 

What are its effects and uses ? 

In small doses it is a mild laxative, in larger amounts a simple 



190 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

purgative. Applied with friction to the abdomen of children it 
frequently purges. It is very useful whenever it is desired to 
evacuate the bowels and remove any irritant materials, as undigested 
food. For this purpose it is often used in acute dysenteries and 
diarrhoeas, especially of children ; dose f3.j-iv (4.0-16.0), best given 
in whiskey and water, in such a manner that the entire inside of the 
glass will be wetted to its margins with the vehicle and the oil form 
a globule surrounded by the fluid ; or it may be given beaten up 
with double the quantity of sherry ; or mixed with equal parts of 
glycerin and flavored with some aromatic oil. 

SULPHUR. 

What is sulphur ? 

Sulphur is a chemical element obtained by purifying native sul- 
phur or by decomposing native sulphides. 

What are its effects, uses and preparations ? 

It acts as a mild laxative and is eliminated in all the excretions. 
Its continued use causes flatulence from the formation of sulphu- 
retted hydrogen. It is used as a laxative, especially in cases of 
hemorrhoids, and as an alterative both internally and externally in 
chronic rheumatism, muscular rheumatism, sciatica, and in various 
forms of skin disease, especially those of parasitic origin. As 
sulphur is excreted largely by the hair, it has been used locally 
and internally in the treatment of alopecia. It is also used as an 
expectorant. It is official as Sulphur Sublimatum {sublimed 
sulphur, sometimes called " flowers of sulphur"), Sulphur Lotum 
{washed sulphur), and Sulphur Pr^ecipitatum (precipitated sid- 
phur) ; dose of either preparation, 3j-iv (4.0-16.0) in syrup. Un- 
GUENTUM Sulphuris [sulphur ointment, containing 30 per cent, of 
washed sulphur) is used externally. 

POTASSA SULPHURATA— SULPHURATED POTASSA. 

What is sulphurated potassa ? 

Sulphurated potassa, or liver of sulphur, is an uncertain com- 
pound containing about 50 per cent, of potassium sulphide. 

In small doses it is decomposed in the stomach and acts like 
sulphur. In large doses it is a gastro-intestinal irritant and has 



CATHARTICS — RHUBARB. 191 

produced death. It may be used to fulfil the indications of sulphur, 
but is chiefly employed as an alterative where a tendency to the 
formation of abscesses exists, in chronic rheumatism and in scaly 
skin affections. It is used externally in the form of bath or oint- 
ment ; dose gr. ij-x (0.1-0.6). 

SIMPLE PURGATIVES. 

What are the simple purgatives ? 

They are medicines employed to produce active purgation, but 
which do not produce sufficient irritation to cause inflammation or 
depression, even when large doses are given. 

Name the agents of this group. 

Castor oil, rhubarb, juglans, aloes, senna, leptandra, euonymus, 
and mercurials. 

Castor oil has been described with the laxatives. 

RHEUM — RHUBARB. JUGLANS. 

What are these medicines ? 

Rhubarb is the root of Rheum officinale [Nat. Ord. Polygon- 
aceae). It contains chrysophan, chrysophanic acid, 4 resins (eryth- 
roretin, emodin, phcerotin and aporetin), rheotannic and rheumic 
acids. It is a tonic, mild purgative, and an astringent owing to 
the rheotannic acid, and hence after purging it has a tendency to 
cause constipation. It tinges the milk and urine yellow, and stim- 
ulates the flow of bile. It is much used in diarrhoea from relaxation, 
in the early stages of summer complaint of children and in dyspepsia 
with constipation. The official preparations and their doses are : 
the extract {extractum rhei), gr. v-xx (0.3-1.3); pills (pih dm rhei) 
each contain gr. iij (0.2) of rhubarb ; compound pills [pilulce rhei 
composite^) each contain gr. ij (0.13) of rhubarb, gr. jss (0.1) of 
aloes, with myrrh and oil of peppermint ; dose No. j-iv ; compound 
powder [pulvis rhei compositus) contains rhubarb and magnesia, 
dose 3ss-j (2.0-4.0); fluid extract (extractum rhei flu id urn), ntxx- 
xxx (1.2-2.0) ; mixture of rhubarb and soda (mistura rhei et sod,m), 
for a child f3ss-j (2.0-4.0), for an adult f3j-iv (4.0-16.0); syrup 
(syrupus rhei), tt^x-xx (0.6-1.2) for an infant; aromatic or spiced 
syrup (syrupus rhei aromaticus), for an infant f^ss-j (2.0-4.0); 
tincture [tinctura rhei), f3j-ij (4.0-8.0); aromatic tincture {tinctura 



192 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

rhei aromaticus), f3ss-j (2.0-4.0) ; sweet tincture (tinctura rhei 
dulcis), f3j-ij (4.0-8.0). 

Juglans is the baric of the root of Juglans cinerea, butternut 
or white walnut (Nat. Orel. Juglandacese), collected in autumn. It 
is used as a substitute for rhubarb, which it resembles in action. 
The extract (extractum juglandis) may be given in doses of gr. 
x-xxx (0.6-2.0). 



ALOE— ALOES. 

What is aloes ? 

Aloes is the inspissated juice of the leaves of Aloe Perryi, socotrine 
aloes (aloe socotrina) and of Aloe vera, Barbadoes aloes (aloe Bar- 
badensis) (Nat. Ord. Liliacese). Each variety contains a neutral 
crystalline principle, aloin. It is a tonic to the mucous membrane 
and a purgative, being slow in its action and affecting principally 
the large intestine, and apparently causing a determination of blood 
to the pelvic viscera. It is also a hepatic stimulant. It is used in 
habitual constipation, especially when torpor of the large bowel 
exists ; in hemorrhoids from relaxation of the veins and congestion 
of the portal circle ; in amenorrhoea and in menorrkagia due to 
want of tone of the uterine vessels. The official preparations are 
made of purified (socotrine) aloes (aloe pimficata), and are, pills 
(pihdee aloes), each containing gr. ij (0.13) of aloes; pills of aloes 
and mastich (pilulce aloes et mastiches), called also Lady Webster s 
dinner-pill, each containing gr. ij (0.13) of aloes; pills of aloes and 
myrrh (pihdee aloes et myrrhce) or Rufus' pill, each containing gr. 
ij (0.13) of aloes ; pill of aloes and iron (pihdee aloes etferri) each 
containing gr. j (0.07) of aloes, of dried ferrous sulphate and of 
aromatic powder (the two last named pills are useful in amenorrhoea) ; 
pills of aloes and asafetida (pilulce aloes et asafcett'da;), each con- 
taining gr. ji (0.09) of aloes, asafetida and soap (useful in flatulent 
dyspepsia with constipation) ; extract (extractum aloes), dose gr. 
j-v (0.06-0.3); tincture (tinctura aloes), dose f.5j-iv (4.0-16.0); 
tincture of aloes and myrrh (tinctura aloes et myrrhce), dose f3j-ij 
(4.0-8.0). 

Aloinum (aloin) is official, dose gr. T VJ (0.006-0.06). 



MERCURIAL CATHARTICS. 193 

SENNA. LEPTANDRA. EUONYMUS. 

What are these medicines ? 

Senna is the leaflets of Cassia acutifolia (Alexandria Senna) and 
of C. angustifolia (Indian Senna) {Nat Ord. Leguminosae). It 
contains cathartic acid, chrysophauic acid, sennit and sennacrol. It 
is a prompt and efficient purgative, and probably acts on the entire 
length of the intestine, causing some griping. It is a mild hepatic 
stimulant. It is used where a prompt and decided cathartic effect 
is desired, usually in combination to prevent griping. Its prepara- 
tions are, the fluid extract (extraction sennce fluidum) dose f3j-iv 
(4.0-16.0); confection (confectio sennce), an^excellent purgative during 
pregnancy, 3j-ij (4.0-8.0); compound infusion (infusum sennce 
compositum), also called black draught, f^ss-iv (15.0-120.0) ; syrup 
(syrupus senna) f3j-ij (4.0-8.0) ; compound powder of glycyrrhiza 
(or of liquorice) (pulvis glycyrrhizce compositus), an excellent purga- 
tive, dose a teaspoonful (4.0) at bedtime. 

Leptandra is the rhizome and roots of Veronica virginica, Culver's 
root or physic (Nat. Ord. Scrophularineae). It contains leptandrin, 
and is a feeble stimulant to the liver and intestinal glands. Dose of 
the extract (extraction leptandra?) gr. j-iv (0.06-0.25) ; of the fluid 
extract (extraction leptandrce fluidum) f^ss-j (2.0-4.0). 

Euonymus, or wahoo, the hark of the root of ID. atropurpureus 
(Nat. Ord. Celastrinege), contains a bitter principle, euonymin, 
resins, euonic acid, etc. ; is a powerful hepatic stimulant, and 
increases the intestinal secretion. It is used as a purgative in tor- 
pidity of the liver and intestines. Dose of the extract (extraction 
euonymi) gr. ij-iv (0.13-0.26) in pill. 



Mercurial Cathartics. 
What mercurials are used as simple purgatives ? 

HYDRARGYRI CHLORIDUM MlTE (merenrons chloride or calomel), 
dose gr. ss-j to'x (0.03-0.6), at bedtime ; and Massa Hydrargyri 
(mercurial or blue mass), dose gr. v-xv (0.3-1.0). The} 7 will be 
found under the head of " Alteratives." 
13 



194 essentials of materia medic a and therapeutics. 
Saline Cathartics. 

What are saline cathartics ? 

The saline cathartics are certain salts which produce an evacuation 
of the bowel not only by increasing peristalsis from their irritant 
effect, but also by promoting outward osmosis from the blood, thus 
rendering the stool liquid, depleting the bloodvessels, and con- 
sequently favoring absorption of effused fluids. 

Name the medicines of this group. 

The magnesium salts, some of the sodium and some of the potas- 
sium salts, and manganese sulphate. 

Describe the effects, uses, preparations, and doses of the mag- 
nesium salts. 
Magnesia {calcined magnesia) and Magnesia Ponderosa 
{heavy magnesia — is similar to Henry's, Husband's, and Ellis' mag- 
nesias) are antacid and cathartic, are mild in their action and 
are excellent preparations for children ; dose as an antacid gr. xx 
(1.2), as a cathartic 3j (4.0) or more. 

Magnesh Carbonas {magnesium carbonate — magnesia alba), 
not much used ; dose as an antacid gr. x-xx (0.6-1.2), as a cathartic 
3j-ij (4.0-8.0). 

Magnesh Sulphas {magnesium sulphate — Epsom salt) is much 
more powerful than the preceding preparations, and produces free, 
watery purgation with very little irritation. It is used as a purga- 
tive to remove fecal accumulations ; as a depletant in entero-colitis 
and acute dysentery (with opium) ; to aid absorption (given in very 
concentrated solutions) in dropsical effusions, especially hydrothorax ; 
and for the relief of colica pictonum and other forms of lead-poison- 
ing; dose 3ss-j (15.0-31.0). 

Magnesh Citras Effervescens {effervescent magnesium citrate), 
dose 3j-iv (4.0-16.0) taken in water while effervescing. 

Liquor Magnesh Citratis {solution of magnesium citrate). 
The citrates are similar in effect to the sulphate, but are more apt to 
irritate ; dose half to a whole bottle full (180.0-360.0 c.c). 

What salts of sodium are used as cathartics ? 
Sodii Sulphas {sodium sulphate— Glauber s salt) is similar in its 



DRASTIC CATHARTICS. 195 

effects to Epsom salt, but more irritant and disagreeable. It is a 
mild hepatic stimulant, It is not much used ; dose 3j-iv (4.0-16.0). 

Sodii Phosphas (sodium phosphate) is a mild cathartic and 
hepatic stimulant. It is an excellent purgative in catarrhal condi- 
tions of the bowel, in catarrhal jaundice, and in chronic infantile 
diarrhoea with pasty stools; dose 3j-^j (4.0-31.0). 

Sodii Pyrophosphas [sodium pyrophosphate) resembles the 
preceding salt in action and uses; dose 5ss-iv (2.0-16.0). 

What potassium salts are used as cathartics ? 

Potassii Sulphas [potassium sulphate) was formerly, but is not 
at present, much used ; dose gr. xv-3j (1.0-4.0). 

Potassii Bitartras (potassium bitartrate — cream of tartar — 
cremor tartar) is a diuretic, refrigerant and cathartic. In overdoses 
it causes gastro-enteritis. Dose as diuretic gr. x-3j (0.6-4.0), as a 
mild laxative 3ss-j (2.0-4.0), as a saline cathartic 3ss (16.0). 

Potassii et Sodii Tartras (potassium and sodium tartrate — 
Rochelle salt) resembles Epsom salt, but is not so powerful ; dose 
gss-j (16.0-31.0). 

Pulyis Effervescens Compositus (compound effervescing pow- 
der — seidlitz powder) consists of Rochelle salt 3ij (7.75) with sodium 
bicarbonate gr. xl (2.59) in a blue, and tartaric acid gr. xxxv 
(2.25) in a white paper, their contents to be dissolved separately, 
the solutions mixed and taken while effervescing, on an empty 
stomach. 

What is manganese sulphate ? 

Mangani Sulphas (manganese sulphate) has been discussed 
with the tonics. It is a hepatic stimulant and cathartic also, resem- 
bling Epsom salt, but is a dangerous remedy, and is not much em- 
ployed ; dose gr. j-v (0.06-0.3). 

Drastic Cathartics. 
What are drastic cathartics ? 

Cathartics which cause much irritation and act very powerfully 
are so called. Most of them in overdoses cause irritant poisoning. 
When they produce very free, watery evacuations they are some- 
times spoken of as " hydragogues. ' ' The more powerful drastics are 
used as revulsives in cerebral affections. 



196 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Describe the medicines employed as drastics. 

Jalapa (jalap), the tuberous root of Ipomoea Jalapa (Nat. Ord. 
Convolvulaceae), a Mexican plant, contains a resin, to which its pur- 
gative properties are due. 

It is a prompt and powerful hydragogue and cholagogue in over- 
doses, causing gastro-intestinal irritation and even death. It is used 
as a hydragogue in dropsies of cardiac or renal origin, as in ascites 
or anasarca, and sometimes as a cerebral revulsant. Its preparations 
are extract [extractum jalapce), dose gr. j-x (0.06-0.6); compound 
powder ( pulvis jalapce compositus), containing 35 percent, of jalap 
with cream of tartar, dose gr. x-3j (0.6-4.0) ; and the resin (resina 
jalapa), dose gr. j-v (0.06-0.3). 

Bryonia (bryony), the root of B. alba and B. dioica (Nat. Ord. 
Cucurbitaceae), European climbing vines, contains a glucoside, bry- 
onin, probably the active principle. It is a violent hydragogue 
cathartic resembling jalap in its effects, and also proving diuretic. 
It is used as a hydragogue in dropsies, especially in hydrothorax and 
hydropericardium. The tincture (tinctura bryonice) may be used in 
doses of f3ss-j (2.0-4.0). 

Podophyllum, the rhizome and roots of P. peltatum, May-apple 
or mandrake [Nat. Ord. Berberidese), a common indigenous plant, 
containing a resinous substance podophyllotoxin, consisting of picro- 
podophyllin, the purgative principle, and podophyllinic acid, which 
is inert. 

It is an active hydragogue and cholagogue, acting slowly and 
especially on the upper part of the small intestine and causing much 
irritation. In overdoses it is a gastro-intestinal irritant capable of 
causing death. 

It is used as a purgative and cholagogue in acute and chronic con- 
stipation, bilious attacks and in torpor of the liver. The dose of 
the extract (extractum podophylli) is gr. v-xv (0.3-1.0) ; of the fluid 
extract (extractum podophylli fluidum) tt\,x-xx (0.6-1.2); of the 
resin gr. 7^- \ (0.006-0.03) ; the latter preparation is the only one 
in common use. 

Podophyllotoxin (not official) may be used in the form of a 1 per 
cent, alcoholic solution, the dose of which is gtt. x-xxx (1.0-3.0). 
It is used hypodermically, dose gr. I (0.016). 



DRASTIC CATHARTICS. 197 

Iris, the rhizome and roots of I. versicolor, or blue-flag [Nat. 
Ord. Irideae) ; contains a purgative resin. It is a powerful stimu- 
lant to the liver and intestinal glands, acting like podophyllum, but 
with less irritation. It is diuretic, and in overdoses irritant and 
depressant, It is used in dropsies, jaundice of malarial origin, and 
torpor of the liver. Dose of the extract (extractum iridis) gr. ij-iv 
(0.1-0.25); of the fluid extract (extractum iridis fluidum) fllx~3j 
(0.6-4.0). 

Chelidonium, celandine or tetterwort, is the herb C. majus {Nat. 
Ord. Papaveraceae) ; contains chderytJirine and chelidonine combined 
with chelidoniuic acid. It is used as a hydragogue cathartic, and is 
supposed to possess cholagogue effects and some narcotic properties. 
It may be given in doses of gr. x-3j (0.6-4.0), in a fluid extract or 
infusion. 

Scammonium (scammony) is a resinous exudation from the living 
root of Convolvulus Scammonia (Nat. Ord. Convolvulaceae), a 
Syrian plant. The resin scammonin is the active portion. It is a 
violent hydragogue, resembling jalap in its action, but much more 
irritating. It is never given except in combination with other 
cathartics. The dose of the resin (resina scammonii) is gr. ij-viij 
(0.13-0.5). It is one of the ingredients of compound extract of 
colocynth. 

Colocynthis (colocynth), the fruit, deprived of the rind, of 
Citrullus colocynthis, or bitter cucumber {Nat. Ord. Cucurbitaceae), 
contains a glucoside (the purgative principle) called colocynthiu, also 
a resin, colocynthitin, etc. 

It is an hepatic stimulant and violent hydragogue, and in over- 
doses causes death from gastro-enteritis. It is never given alone, 
but is used in small doses to increase the effects of milder cathartics. 
The extract (extractum colocynthidis) is used in combination with 
other purgatives, dose gr. ij-v (0.13-0.3); compound extract [ex- 
tractum colocynthidis compositum) containing also aloes, resin of 
scammony, cardamom and soap, dose gr. iij-x (0.2-0.64). 

Cambogia (gamboge) is a gum-resin obtained from Grarcinia 



198 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

Hanburii {Nat. Ord. Guttiferae), a tree of Siam. The resin is the 
purgative principle and is called cambogic acid. It is a very power- 
ful hydragogue cathartic, and in overdoses has caused death. It is 
rarely used alone. Dose gr. ij-v (0.13-0.3). 

Piluls Cathartics Composite {compound cathartic pills). 
Each pill contains of compound extract of colocynth gr. j£ (0.08), 
of calomel and of extract of jalap each gr. j (0.06) and of gamboge 
gr. \ (0.015). 

Piluls Cathartics Vegitabiles [vegetable cathartic pills). 
Each pill contains of compound extract of colocynth gr. j (0.06), of 
extract of hyoscyanius and of jalap each gr. ss (0.03), of extract of 
leptandrin and of resin of podophyllum each gr. \ (0.015) with oil of 
peppermint, 

Elaterinum (elaterin) is a neutral principle extracted from Ela- 
terium, a substance deposited by the juice of the fruit of Ecballium 
Elaterium, or squirting cucumber (Nat. Ord. Cucurbitaceae). It is 
one of the most powerful of the hydragogues, also proving diuretic, 
and in excessive doses often causing death. It is much used in 
dropsies, in urcemia and as a cerebral revulsive. The dose is gr. ^ 
(0.003); of the trituration (trituratio elaterini) gr. ]-ss (0.016-0.03). 

Oleum Tiglii {croton oil) is a fixed oil expressed from the seeds 
of Croton Tiglium {Nat. Ord. Euphorbiaceae), a tree of India. The 
active principle has not been isolated. 

When applied to the skin croton oil is an intense irritant, causing 
a papular eruption which soon becomes pustular. Given internally 
it is a powerful and rapid hydragogue cathartic, causing severe 
griping pains and to some extent depressing the circulation. In 
overdoses it produces great depression and often proves fatal. In 
obstinate constipation it is very serviceable, and as a revulsive in 
cerebral affections, as apoplexy, it is the best hydragogue. It has 
been used externally as a counter-irritant (q. v. ). Dose gtt. j (0.016- 
0.12), which may be given in pill or emulsion, or mixed with a few 
drops of glycerin or olive oil and placed on the patient's tongue 
when he cannot or will not swallow. 



ANTHELMINTICS. 199 

Enemata. 
What are enemata ? 

Enemata are liquids injected into the rectum. They may be 
nutritive, cathartic, or forced enemata. 

Nutritive enemata are used to nourish the patient when the 
stomach cannot retain or digest food. They should be small in 
amount, not exceeding f.^iij-iv (90.0-120.0) at a time, nor should 
they be too frequently repeated, else they will cause irritability of 
the rectum. They should be combined with some digestant, as 
pepsin or pancreatin. 

Cathartic enemata are used to unload the bowels when irritation 
or inflammation of the stomach is present ; to aid the action of 
cathartics taken by the mouth ; to remove faecal accumulations or 
retained and irritating secretions from the large intestine ; to relieve 
tympanites ; to remove ascarides ; or to act as revulsives. The fluid 
used may be cold or warm water, either simple or medicated, and 
the quantity will depend on the case. The injection should be made 
slowly and carefully, and the introduction of air is to be avoided. 

Forced enemata are made slowly and gradually, the fluid, either 
warm water or warmed oil, being poured into a large funnel or rub- 
ber bag (fountain syringe) to which a long rubber tube is attached, 
armed with an injection pipe. By elevating the funnel or bag the 
fluid flows in a steady stream, the force being regulated by the 
height at which the bag is held. Forced enemata are employed 
principally to reduce intussusception of the bowels. 

ORDER V. — Anthelmintics. 

What are anthelmintics? 

Anthelmintics are medicines used to kill {vermicides) or cause the 
expulsion of {vermifuges) intestinal worms. 

How are they administered'? 

They should be given fasting, and should be followed in 4 to 6 
hours by a purgative, as calomel or castor oil. 

Describe the medicines nsed as anthelmintics. 

SpiCxELIA, or pinkroot, the rhizome and roots of S. marilandica 
or Carolina pink {Nat Ord. Loganiacese), contains a bitter principle, 



200 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

volatile oil, resin, tannic acid, etc. It slows the heart by stimulating 
the inhibiting centres, reduces arterial pressure by depressing the 
heart, and in overdoses quickens the pulse, increases the blood- 
pressure, dilates the pupil, causes delirium, and, in fatal cases, death 
from respiratory paralysis. It is very efficient in causing the expul- 
sion of lumbrici, but should be followed by a purge. Dose of the 
fluid extract (extraction spigelian fluidum) f3j-ij (4.0-8.0), or to a 
child gtt. x (0.5) on sugar. 

Chenopoditjm or American wormseed, the fruit of C. ambrosi- 
oides or Jerusalem oak (Nat. Ord. Chenopodiaceae), contains a 
volatile oil, to which its effects are due. It is a very efficient remedy 
for the expulsion of lumbrici, and should be followed by a brisk 
cathartic. The oil (oleum chenopodii) is given in doses of gtt. v-x 
(0.25-0.5) on sugar, to a child 3 years old, before meals. 

Santonica or Levant wormseed is the unexpanded flower-heads 
of Artemisia pauciflora (Nat. Ord, Composite). The active prin- 
ciple is santonin. Large doses cause salivation, rapid breathing, slow, 
labored pulse, trembling, yellow vision and yellow urine, unconscious- 
ness, convulsions, dilated pupils and death. It is used almost exclu- 
sively as a remedy for lumbrici. Dose of santonin (santoninum) for 
an adult gr. ss-v (0.03-0.3); for a child 2 years old gr. I (0.016). 
Troches of santonin (trochisci santonini) each contain gr. ss (0.03) 
of santonin, dose 1 to 6 troches. 

Aspidium, the rhizome of Dryopteris filix-mas, or male fern, and 
D. marginale (Nat. Ord, Filices), contains filicic acid, volatile and 
fixed oils, resin, etc., and is used as a tceniacide. Like all reme- 
dies employed for this purpose, its administration should be preceded 
by a fast of 24 hours and followed by a brisk cathartic. In over- 
doses it has caused death from enteritis. Dose of the oleoresin 
(oleoresina aspidii) f^ss-j (2.0-4.0). 

GrRANATUM (pomegranate), the bark of the stem and root of 
Punica Granatum (Nat. Ord. Lythrariese), contains four alkaloids, 
pellet -ferine : and three allied alkaloids, which are powerful tamiacides, 
as is also granatum itself. In overdoses they are said to act on the 
muscles like woorara. Dose of pomegranate in decoction (^ij 
(59.147) to water Oij (946.358) boiled to Oj (473.179)) fgij (59.147) 
repeated 3 times at an hour's interval, before breakfast; of pelle- 
tierine tannate gr. v-x (0.3-0.6). 



ANTHELMINTICS. 



201 



Cusso (Kousso; Brayera, Pharm. 1880), the female inflorescence 
of Hagenia abyssinica (Nat. Ord. Rosacea*), contains protokosin 
(a crystalline, inactive resin) and kosotoxin (an amorphous, highly 
active resin), and is used as a tceniacide; dose of the fluid extract 
{extractum cusso fluidum) , f3ij-iv (8.0-15.0). 

Kamala, the glands and hairs from the capsules of Mallotus 
philippinensis (Nat Ord. Euphorbiaceae), contains rottlerin and 
isorottlerin, resinoid substances, and is used as a tceniacide; dose 
5j-ij (4.0-8.0) of the powder in syrup, or given in the form of 
tincture. 

Pepo (pumpkin-seed), the seed of the Cucurbita pepo or pumpkin 
(Nat. Ord. Cucurbitaceae), contains a resin, and is one of the most 
powerful twniacides in the materia medica and perfectly harmless ; 
dose of the fresh seed (powdered with sugar) ^j-ij (30.0-65.0). 

Oleum Terebinthin^e (oil of turpentine) is an efficient but not 
a harmless remedy for tasnia and lumbrici. It will be found under 
the head of "Diuretics." Dose f^ss-j (15.0-30.0) combined with 
castor oil. 

Hydrargyri Chloridum Mite (mercurom chloride or calomel) 
is used alone or combined with other anthelmintics for the expulsion 
of lumbrici and (rarely) to?,nia. It should be given in full purgative 
doses (v. Alteratives). 

What remedies are used for the destruction of ascarides ? 

Mild purgatives, as calomel or sulphur, may be used to dislodge 
them from the small intestines, but injections of quassia-infusion, 
common salt, naphtol, tannin, alum or lime ivater must be employed 
to get rid of those in the colon. Injections of sweet oil at bedtime 
are useful to kill any which may be in the rectum, and prevent the 
excessive itching which they cause. The child should be prevented 
from scratching the anus, as the ova are very tenacious, and adhering 
to the finger nails may be conveyed to the mouth and reproduce the 
trouble. 

What are useful adjuncts to the anthelmintics? 

Iron and the bitter tonics, by restoring tone to the mucous mem- 
branes, prevent the excessive secretion of mucus which forms a suit- 
able nidus for the development of parasites. 



202 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 



Class III.— Medicines acting on the body by 

their effect on the various secretions 

and excretions. 

ORDER I.— Diuretics. 

What are diuretics? 

Diuretics are medicines used to increase the excretion of urine, 
acting either directly on the secreting cells of the kidney, or indit 
rectly by their influence on the blood-pressure in the glomeruli. 

For what purposes are they used? 

They are used (1) to maintain the function of the kidneys in sup- 
pression of urine independent of the cause ; (2) to promote the 
excretion of urinary solids (injurious waste products) or of poisons 
from the blood, as in uraemia, gout, rheumatism, fevers, and in 
cases of various metallic and vegetable poisons ; (3) to promote the 
excretion of water, thus tending to dilute highly concentrated urine 
or to aid in the removal of effused (dropsical) fluids ; and (4) to alter 
the chemical reaction of the urine and render that fluid more bland, 
thus lessening vesical and urethral irritation and any tendency which 
may exist to the formation of calculi. 

A certain relation exists between the functions of the skin, kid- 
neys and bowels, so that free catharsis or free diaphoresis will dimin- 
ish the urinary secretion and vice versd. 

How may diuretics be classified? 

They may be divided into alkaline, hydragogue and alterative 
diuretics. 

ALKALINE DIURETICS. 

What are the alkaline diuretics ? 

They are those salts which, without materially increasing the 
amount of water, usually increase the elimination of its solid ingre- 
dients and modify or alter its chemical reaction. 

Name the alkaline diuretics. 

The potassium and lithium salts, and strontium lactate. 



DIURETICS— POTASSIUM. 203 

POTASSIUM. 

What is the source of potassium? 

Potassium is obtained from the ashes of plants, from native nitre, 
and from tartar or argol, deposited from wine during fermentation. 

What are the general physiological actions of its salts ? 

Locally applied caustic potash destroys tissues by abstracting water, 
dissolving albumin and saponifying fats. Internally in small doses 
before meals, they increase the acidity of the gastric juice ; in large 
doses, or after meals, they neutralize the acid present in the stomach. 
The bicarbonates, when taken on an empty stomach, enter the blood 
readily, and abstracting the base from basic and neutral potassium phos- 
phate convert it into the acid phosphate, thus increasing the acidity of 
the mine ; but if taken after or during meals, they are decomposed in 
the stomach, and entering the blood as a carbonate, diminish the 
acidity of the urine. The salts formed with the vegetable acids are 
converted into carbonates in the system and render the urine less 
acid. Potassium and its salts promote oxidation (and hence cause 
emaciation when used continuously), decreasing the amount of uric 
acid and increasing the urea excreted by the urine. The nitrate 
and chlorate are not decomposed in the system, and having effects 
peculiar to themselves, will be separately considered. All the po- 
tassium salts are protoplasmic poisons, in very large doses paralyzing 
the heart in diastole by direct action on its muscle and contained 
ganglia. They also depress and paralyze the functions of the 
brain and spinal cord. They all prove diuretic, increasing the 
amount of water passed and, by promoting oxidation, the elimina- 
tion of urea. Poisoning by caustic potash is due to its corrosive 
properties, and if recovery takes place from the acute effects, various 
stenoses are apt to follow. The carbonate in overdoses causes vio- 
lent gastro-enteritis with great cardiac depression and sometimes par- 
alysis. The treatment of potassium poisoning consists in neutralizing 
the alkali by a vegetable acid, giving demulcents and fixed oils as 
protectives, and stimulating if requisite. 

What are the therapeutical uses of the potassium salts ? 

The potassium salts are used as diuretics (increasing as they do 
both the water and salts of the urine, and converting uric acid into 



204 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

the more soluble urea as well as rendering the urine alkaline) in acute 
rheumatism, uric acid diathesis, in desquamative nephritis, and to 
alkalinize the urine in cystic and urethral irritation. 

What are the potassium preparations, their uses and doses ? 

Liquor Potass^e {solution of potassa) contains 5 per cent, of 
potassium hydrate, and is antacid and diuretic. It is used to render 
the urine alkaline in cystic irritability and in gonorrhoea ; dose m,x- 
xx (0.6-1.2) freely diluted. 

Potassii Carbonas (potassium carbonate) is antacid and diu- 
retic, but is more irritating to the stomach than the bicarbonate ; 
dose gr. x-xx (0.6-1.2). 

Potassii Bicarbonas (potassium bicarbonate) is antacid and 
diuretic; dose gr. xx-3j (1.2-4.0). It is much used in the treat- 
ment of acute rheumatism, especially in plethoric persons (3jss 
(45.0) are given in the first twenty-four hours, half as much during 
the second day, and afterward enough to keep the urine alkaline). 

Potassii Citras (potassium citrate) is used as a diuretic in acute 
rheumatism and as a refrigerant diaphoretic in fevers and acute in- 
flammations ; dose gr. xx (1.2) in solution every hour or two. 

Liquor Potassii Citratis (solution of potassium citrate) con- 
tains 8 per cent, of the bicarbonate and 6 per cent, of citric acid. 
It is often prescribed with sweet spirits of nitre, in fever mixtures ; 
dose f^ss (15.0). 

Potassii Citras Effervescens [effervescent potassium citrate) is 
made by mixing thoroughly, drying and powdering citric acid (63.0), 
potassium bicarbonate (90.0), and sugar (47.0). Dose 3ss-j (2.0-4.0). 

Neutral mixture (not official) is made by neutralizing fresh lemon- 
juice, with the bicarbonate. The official solution of potassium citrate 
has superseded it, as being the more exact and more elegant method 
of prescribing the same medicine; dose fjss-j (15.0-30.0). 

Effervescing draught (not official) is made by adding f^j (29.57) 
of a solution of the bicarbonate (3j (3.88)-f^iij (88.7)) to f£j 
(29.57) of lemon-juice and water (equal parts). It is particularly 
acceptable to febrile patients with irritable stomachs. 

Potassii Acetas (potassium acetate) is antacid, diuretic, and in 
large doses a mild cathartic. It is chiefly used as a diuretic in acute 
rheumatism and to some extent in dropsies, and in uric acid diathesis ; 
dose gr. xx-3j (1.2-4.0). 



DIURETICS— POTASSIUM. 205 

Potassii BlTARTRAS {potassium bitartrate — cream of tartar) is 
a diuretic and saline cathartic (q. v.) much employed in dropsies. 

Potassii Nitras {potassium nitrate — saltpetre — nitre) locally 
applied is a powerful irritant to the mucous membranes and to raw 
surfaces. It passes through the system unchanged, and is elimi- 
nated chiefly by the urine, increasing the amount passed but not 
affecting its reaction to the same extent as the other salts. Poison- 
ing occurs more frequently from the nitrate than from any other 
potassium salt, the symptoms being burning pain in the throat and 
epigastrium, hsemateniesis and bloody stools, muscular weakness, 
syncope, collapse sometimes preceded by convulsions or paralysis, 
suppression of urine and death. The treatment consists in evacu- 
ating the contents of the stomach and administering opiates, de- 
mulcents and stimulants. 

It is used in acute rheumatism as a diuretic, but is probably inferior 
to the salts formed with the vegetable acids. It is used in fevers for 
the same purpose and has been given in small doses combined with 
Dover's powder as a diaphoretic in acute muscular rheumatism. 
Dose of potassium nitrate gr. x-xxx (0. 6-1 .9). Papers of potassium, 
nitrate (charta potassii nifratis), consisting of strips of unsized 
paper immersed in a 20 per cent, solution of the salt, are burned 
and the fumes inhaled with success in spasmodic asthma. It is 
probable that the nitrite is formed by the combustion and is the 
active agent in these cases. 

Potassii Chloras {potassium chlorate) is a local irritant. Inter- 
nally in large doses it causes gastro-enteritis, affects the circulation 
as do the other potassium salts, damages the blood corpuscles and 
interferes with oxygenation by the formation of niethsemoglobin, and 
produces a condition of acute tubal nephritis. Cases of poisoning 
are not infrequent, and death is usually preceded by profuse saliva- 
tion, great dyspnoea, cyanosis, delirium, coma, tonic and clonic 
spasms, and sometimes ecchymoses and jaundice. It increases the 
excretion of urine, but does not affect its chemical reaction. 

It has been used as a diuretic in dropsies, but is dangerous and 
inferior to other preparations. As an alterative in the exanthemata 
it is now little employed. In mercurial, follicular or aphthous 
stomatitis it is of unquestionable value, given internally with sugar 
or used as a gargle. In ordinary sore throat and in tonsillitis it is 



206 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

useful as a local application ; dose gr. v-xxx (0.3-2.0). It must be 
given freely diluted. It should not be prescribed in powder with 
readily oxidizable or combustible substances, as when triturated with 
them it forms explosive compounds. As a gargle 3ss-iv (2.0-15.0) 
in water Oj (473.1) may be used. 

The troches {trochisci potass ii chloratis) each contain gr. v (0.3) 
of the salt. 

The other potassium preparations have been or will be considered 
in their appropriate place. 

LITHIUM. 

What are the sources of lithium ? 

Lithium is a chemical element, found native in the form of sili- 
cates, phosphates, etc. 

What are the physiological effects aud uses of the lithium 
salts? 
The lithium salts appear to resemble those of potassium. They 
are eliminated by the urine as urates, increasing the urine and ren- 
dering it much more strongly alkaline than a corresponding amount 
of a potassium salt. As the urate of lithium is much more soluble 
than either the urate of sodium or of potassium, the lithium prepa- 
rations are advantageously used in the treatment of chronic gout and 
lithcemia, and as a local application to gouty deposits either before 
or after the skin has broken. It has also been employed internally 
in glycosuria. 

What are the preparations of lithium and their doses ? 

Lithii Carbonas (lithium carbonate), dose gr. v-x (0.3-0.6) 
freely diluted. As a local sorbefacient for gouty deposits a solution 
(gr. v (0.3)-f^j (30.0)) should be kept constantly applied. 

Lithii Citras {lithium citrate), dose gr. v-xx (0.3-1.2). 

Lithii Citras Effervescens {effervescent lithium citrate) is made 
by triturating and thoroughly drying citric acid (370.0) with sugar 
(about 200.0) ; then triturating the mixture with lithium carbonate 
(70.0), sodium bicarbonate (280.0) and sugar (enough to make the 
product weigh 1000.0). Dose 3j-ij (4.0-8.0). 

Lithii Benzoas {lithium benzoate), dose gr. v-xx (0.3-1.2). 

Lithium bromide and L. salicylate have been previously men- 
tioned. 



DIURETICS — LITHIUM. 207 

What sodium salt has been used as a diuretic ? 

Sodii Acetas {sodium acetate) is supposed to possess properties 
similar to those of potassium acetate, and has been used for the 
same purposes and in the same doses. 

What preparation of strontium is used as a diuretic ? 

Strontii Lactas {strontium lactate) has been used as a diuretic, 
especially in acute desquamative nephritis, with scanty urine, where 
it has been found to increase the amount of urine and diminish the 
albumin present in that excretion. It has also been used in other 
forms of kidney disease, but is much less efficient in chronic than in 
acute cases. It has been used as an intestinal antiseptic, but is of 
little value for this purpose. Dose gr. v-xv (0.3-1.0) in solution. 

Hydragogue Diuretics. 

What are hydragogue diuretics ? 

The medicines of this group greatly increase the flow of the 
watery element of the urine, and are hence used in the treatment 
of dropsies. 
Name the hydragogue diuretics ? 

Squill, digitalis, caffeine, sodio-theobromine salicylate, apocynum, 
broom, dandelion, sweet spirit of nitre, and mercurials. 

SCILLA— SQUILL. 

What is squill? 

Squill is the bulb of Urginea maritima {Nat. Ord. Liliaceae) 
deprived of its dry, membranous outer scales, and cut into thin 
slices, the central portions being rejected. It contains scillipicrin, 
scillitoxin, and scillin. In small doses squill increases the mucous 
secretions and is a stimulating expectorant, while it markedly 
increases the urinary secretion. In large doses it causes nausea, 
vomiting, and sometimes purging, and in excessive doses produces 
in addition great abdominal pain, with scanty, bloody, or even sup- 
pressed urine, great depression, collapse, convulsions and death. 

Scillipiciin appears to be the diuretic principle. Scillitoxin slows 
the pulse, and in overdoses causes diastolic cardiac arrest by stimu- 
lating the peripheral vagi ; after large doses the vagi are finally 
paralyzed and the pulse becomes rapid. Scillin is devoid of diuretic 
effects, but appears to be the emetic principle. 



208 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

The treatment of poisoning consists of evacuating the contents of 
the stomach and the use of opiates and demulcents. If collapse 
occurs alcohol must be employed. 

Squill is used as a diuretic in dropsy, but should not be employed 
if kidney disease or cystitis is present. It is frequently combined 
with digitalis in cardiac dropsies, and in chronic pleurisy or peri- 
carditis is often given with calomel. As an expectorant it is much 
used in bronchial affections. As an emetic it is too dangerous a 
remedy to employ. 

As a diuretic or expectorant squill may be given in doses of gr. j-ij 
(0.06-0.13) repeated every 2 hours and gradually increased until 
nausea occurs. Doses of gr. vj-xij (0.389-0.778) generally prove 
emetic. The dose of the fluid extract {extractum scillw fluidum) is 
n\j-ij (0.06-0. 12) ; of the tincture (tinctura scillce) nu-xxx (0.6-1.8) ; 
of the vinegar {acetum scillce) ntx-xxx (0.6-1.8); of the syrup 
[syrupus scillce) f3ss-j (2.0-4.0); of the compound syrup {syrupus 
scillce compos itus — Coxes hive syrup), containing squill and senega 
and gr. j (0.059) of tartar emetic in each ounce (29.5), TT\,v-f3j 
(0.3-4.0). 

DIGITALIS — CAFFEINE. 

Are these drugs used as diuretics ? 

The uses of these remedies as diuretics have already been discussed 
under the head of ' ' Cardiac Stimulants. ' ' For this purpose the best 
preparations of digitalis are the infusion, the powdered leaves or the 
tincture. 

SODIO-THEOBROMINE SALICYLATE. 

What is sodio-theobromine salicylate ? 

Sodio-theobromine salicylate, or diuretin {the proprietary name), 
is a non-official preparation "obtained by mixing aqueous solutions 
of equal molecules of sodium theobromine and salicylic acid, and 
evaporating to dryness ; a definite compound appears to be formed 
containing theoretically 49.7 per cent, of theobromine and 38.1 per 
cent, of salicylic acid. It occurs as a white powder, odorless, of a 
saline, alkaline taste, and soluble in one-half its weight of warm 
water, the solution remaining perfect on cooling."* 

* National Dispensatory. 



DIURETICS— SODIO-THEOBROMINE SALICYLATE. 209 

Its physiological action is not fully understood. It is a powerful 
diuretic in certain diseased conditions, as when anasarca is present, 
due to disease of the heart or kidneys, but appears to have no 
diuretic effect when given to healthy persons. 

It has little if any effect upon the circulation except in the dis- 
eased conditions above mentioned, when it appears to increase the 
force and render more regular the beat of the heart, probably by 
increasing diuresis and removing the fluid which has been acting as 
a mechanical obstruction to the circulation. 

The action on the kidneys is not understood, but is non -irritating 
in character. Under its use the amount of solid as well as the fluid 
of the urine is much increased, the latter sometimes enormously, 
as much as three gallons of urine having been reported as passed 
in 24 hours while using the drug. As the dropsical accumulation 
diminishes, the amount of urine lessens. 

Sometimes sodio-theobromine salicylate causes "nervousness," 
headache or vertigo, tinnitus aurium, and palpitation. Occasionally 
a rise in temperature is seen after its use. In rare cases a cutaneous 
eruption attended with more or less intense itching appears. More 
frequently, however, it acts as a gastro-intestinal irritant, causing 
loss of appetite, nausea, and sometimes severe vomiting and 
purging. 

The therapeutical uses of this drug are indicated by what has been 
already said. It is of great value in all dropsical effusions depend- 
ing on disease of the kidney or heart, and should always be tried in 
these conditions when remedies like digitalis, strophanthus, etc., have 
not succeeded in reducing the dropsy. In pleuritic effusions it is 
not so certain in its action. In ascites due to portal obstruction it 
usually appears to produce no effect. In dropsies dependent on 
tubercular inflammation it is absolutely valueless. Dose gr. xv (1.0) 
repeated every 2 or 3 hours until some effect is produced. The 
author has never found it necessary to give more than 3jss (6.0) in 
24 hours, although some observers have prescribed double that 
quantity in the same period of time without ill effect. It is admin- 
istered in solution in plain water flavored with peppermint or other 
aromatic. It may be given in capsules. 
14 



210 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
APOCYNUM. 

What is apocynum ? 

Apocynum, Canadian hemp, or milk-weed, is the root of A. 
cannabinum {Nat. Ord. Apocynacese) and contains apocynin and 
apocyne'in, a glucoside. These substances are supposed to be cardiac 
tonics, acting on the heart similarly to digitalis. They are also 
diuretic. Apocynum is laxative in small, but emetic and cathartic 
in large doses. It is chiefly used as a diuretic in dropsies, and should 
not be given in quantities sufficient to purge when the former effect 
is desired; extractum apocyni fluidum {fluid extract of apocynum), 
doseTTW-xxx (0.3-2.0). 

SCOPARIUS. 

What is scoparius ? 

Scoparius is the tops of Cytisus Scoparius or broom (Nat. Ord. 
Leguminosse), and contains a volatile liquid alkaloid, sparteine (v. 
" Cardiac Stimulants"), and a neutral principle, scoparin, in which 
the diuretic properties are supposed to reside. Broom is an efficient 
hydragogue diuretic, and in large doses produces free purging and 
sometimes vomiting. It is much used in the treatment of dropsies 
and is best given in decoction (^ss (14.7) to water Oj (473.1) boiled 
down to Oss (236.5), dose foj (30.0) every 2 or 3 hours until an 
effect is produced) or the fluid extract (extractum scoparii fluidum) 
may be given in doses of f3ss-j (2.0-4.0). 

TARAXACUM. 

What is taraxacum ? 

It is the root of Taraxacum officinale or dandelion ((Nat Ord. 
Composite) gathered in the autumn, and contains a bitter principle, 
taraxacin ; also taraxacerin, imdin, resin, etc. 

It is diuretic, laxacive, and slightly cholagogue, and is used in 
dropsies of hepatic origin and dyspepsia with torpor of the liver. 
Dose of the extract (extractum taraxaci) gr. xx-5j (1.28-4.0), of 
the fluid extract {extractum taraxaci fluidum) f3j-ij (4.0-8.0). 

SPIRITUS ^THERIS NITROSI — SPIRIT OF NITROUS ETHER. 

Is this medicine a diuretic ? 

Sioeet spirit of nitre is diuretic in large doses if the surface of the 
body is kept cool. It is usually combined with other diuretics, but 



DIURETICS — PAREIRA. 211 

may be given alone where the urinary secretion is scanty from simple 
congestion or from purely functional causes. It will be considered 
more fully under "Diaphoretics." Dose f3j-iv (4.0-15.0) freely 
diluted. 



MERCURIALS. 

Axe the mercurial preparations ever used as diuretics ? 

Calomel (q. v.) has been employed as a diuretic in cardiac dropsy, 
dose gr. iss 4 or 5 times a day. It is a useful adjunct to squill in 
hydrothorax and hydropericardium. 

Corrosive sublimate will probably prove to be a more powerful 
diuretic, as by its action on the liver it increases the formation of 
urea, which of itself always increases the excretion of water by the 
urine. 

Alterative Diuretics. 
What are alterative diuretics ? 

They are medicines which are employed not only as diuretics but 
also for their effect on the mucous membrane of the urinary tract, 
by which they are possibly to some extent excreted, or on which 
they exercise an alterant and sedative effect during their passage in 
the urine. 

Name the medicines belonging to this group. 

Buchu, pareira, uva ursi, chimaphila, triticum, juniper, oil of 
erigeron, oil of santal, stigmata maydis, turpentine, copaiba, cubeb, 
matico, cantharides. 

BUCBU. PAREIRA. 

What are these medicines ? 

Buchu, the leaves of Barosma betulina and other species (Nat 
Ord. Rutaceae), natives of S. Africa, contains a volatile oil and a 
bitter principle. It is a mild tonic and diuretic, and slightly stimu- 
lates the genito-urinary mucous membranes, having also an altera- 
tive effect upon them. 

It is used in chronic catarrhal conditions of the genito-urinary 
mucous tract, as chronic pyelitis, chronic cystitis and especially in 
irritation of the neck of the bladder ; dose of the fluid extract 
(extractum buchu fluidum) f^ss-j (2.0-4.0). 



212 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Pareira, the root of Chondodendron tormentosum {Nat. Ord. 
Menispermaceae), a Brazilian plant, contains a bitter alkaloid, cissam- 
peline, and has been nsed with success in the treatment of chronic 
cystitis, gleet and ' ' irritable bladder. " It is said to be also tonic 
and laxative. Dose of the fluid extract {extractum pareiroe, fluidum) 
f5sB-j (2.0-4.0). 

UVA URSI. CHIMAPHILA. 

What are these medicines ? 

Uva Ursi is the leaves of Arctostaphylos Uva ursi or bearberry 
{Nat. Ord. Ericaceae), and contains tannic and gallic acid, a gluco- 
side called arbutin, ericolin (a bitter substance), etc. It is used as 
a mild astringent tonic, and diuretic in chronic pyelitis and cystitis, 
and has also been employed in chronic bronchitis. 

Arbutin is the diuretic principle, and as it is, partially at least, 
eliminated as hydroquinone {vid. "Antipyretics"), it is supposed 
to act as an antiseptic to the urogenital tract. It has been employed 
in the above diseases and internally in gonorrhoea. 

Dose of the fluid extract {extractum uvce ursi fluidum) f3ss-ij 
(2.0-8.0), t. i. d. ; of the extract {extractum uvce ursi) gr. v-x 
(0.3-0.9). 

Chimaphila, the leaves of C. umbellata, pipsissewa, wintergreen, 
or ground holly {Nat. Ord. Ericaceae), contains arbutin, tannic acid, 
chimaphilin, etc. It is tonic, astringent, and diuretic, resembling 
buchu and uva-ursi in its effects and uses. Special alterative qualities 
have been claimed for it in scrofulous affections. 

Dose of the fluid extract {extractum chimaphiloz fluidum) f3ss-j 
(2.0-4.0), t. i. d. 

TRITICUM. 

What is triticum ? 

Triticum, the rhizome of Agropyrum repens or couch grass {Nat. 
Ord. Gramineae), contains triticin and several sugars, and is feebly 
diuretic. It is useful in cystitis and in irritation of the neck of the 
bladder. 

Dose of the fluid extract {extractum tritici fluidum) f3ss-ij (2.0- 
8.0). 



DIURETICS— OIL OF SANTAL. 213 

JUNIPERUS— JUNIPER. 

What is juniper? 

Juniperus [juniper) (not official) is the fruit (or berries) of J. 
communis (Nat. Ord. Coniferae), and contains a volatile oil (oleum 
juniperi, dose gtt. v-xv (0. 3-0.9)), on which its diuretic effects depend. 
It is a stimulant to the kidneys, capable in overdoses of causing 
strangury and bloody urine, and is sometimes used as an emmen- 
agogue. It is chiefly employed as an adjuvant to other diuretics, 
particularly the alkaline group. As an alterative diuretic it is used in 
chronic pyelitis and chronic cystitis. It is sometimes given in subacute 
renal congestion, but is contraindicated where active inflammation is 
present. It is occasionally used as a carminative and stomachic. 
The preparations (official) are the spirit (spiritus juniperi), containing 
5 per cent, of the oil, dose 3j-ij (4.0-8.0); the compound spirit 
(spiritus juniperi compositus) contains also the oils of caraway and 
fennel in alcohol and water, and is about the same strength as gin, 
which is often used as a substitute for it, dose f3j-jv (4.0-15.0). 

OLEUM ERIGERONTIS— OIL OF ERIGERON. 

What is the oil of erigeron ? 

It is the oil distilled from the fresh flowering herb of Erigeron 
canadense, or Canada fleabane (Nat. Ord. Composite), and yields 
on distillation a resin and a terpene. It is diuretic and hemostatic, 
and is useful in hemorrhages due to relaxation of the genito-urinary 
mucous membrane. It has been used with success in gonorrhoea. 
Dose ff\.v-xxx (0.3-2.0) on sugar or in capsule, every two or three 
hours. 

OLEUM SANTALI — OIL OF SANTAL. 

What is the oil of santal? 

It is a volatile oil distilled from the wood of Santalum album 
(Nat. Ord. Santalaceae). It is an alterative, diuretic, and blennor- 
rhetic, sometimes causing vertigo, when its use should be discon- 
tinued or the dose decreased. Occasionally it produces gastro- 
intestinal irritation. It is used in the second stage of gonorrhoea, 
and in chronic bronchitis it is often beneficial ; dose ^Lv-xx (0.3-1.2) 
in emulsion or capsule, t. i. d. 



214 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

ZEA. 

What is this substance ? 

Zea, or corn silk, the styles and stigmas of Zea Mays or Indian 
corn (Nat. Ord. Graniinese), is a mild, stimulating diuretic, and is 
strongly recommended in cystitis, both acute and chronic, in gonor- 
rhoea, in irritability of the bladder depending upon a highly concen- 
trated urine, in nocturnal incontinence in children, and even in 
cardiac dropsy. It is given in infusion ad libitum, or in the form 
of fluid extract (extractum zecefluidum), of which the dose is f3j-ij 
(4.0-8.0) every hour or two. 

TEREBINTHINA — TURPENTINE. 

What are the officinal varieties of turpentine ? 

1. Terebinthina (turpentine or white turpentine) is a concrete 
oleoresin obtained from Pinus palustris, yellow or pitch pine, and 
other varieties of Pinus (Nat Ord. Coniferse) trees indigenous to 
the Southern States. 

2. Terebinthina Canadensis (Canada turpentine, Canada 
balsam or balsam of fir) is a liquid oleoresin obtained from 
Abies balsamea, the American silver fir, or balm of gilead tree 
{Nat Ord. Coniferae), found in the northern portions of N. 
America. 

3. Unofiicinal varieties known to commerce are Chian turpentine 
derived from Pistacea Terebinthinus (Nat Ord. Anacardaceae), 
formerly used as a specific for internal (especially uterine) cancer, 
but possessing no curative power ; Bordeaux turpentine, Venice tur- 
pentine, etc. 

What do the turpentines contain ? 

They contain a resin, or rosin (resina) united to a volatile oil 
(oleum terebinthina^). 

What are the effects and uses of turpentine ? 

The effects of turpentine are those of the oil which it contains. 
They are rarely used internally, but have been given as an alterative 
to the broncho-pulmonary and genito-urinary mucous membranes 
in chronic catarrhal conditions, and have been used as an anthel- 
mintic, but for all these purposes the oil is preferred. 

Dose as a diuretic and blennorrhetic gr. xx~3j (1.3-4.0), in pill or 
emulsion; as an anthelmintic Sss-j (15.5-31.0). 



DIURETICS — OIL OF TURPENTINE. 215 

Resina (resin) is only used externally as a basis for plasters and 
ointments. Its preparations are a cerate (ceratum resince), sometimes 
called basilicon ointment, and a, plaster [emplastrum resince), adhesive 
or sticking plaster. 

OLEUM terebinthin^:— oil of turpentine. 

What is the oil of turpentine ? 

Oil of turpentine or spirit of turpentine is a volatile oil distilled 
from turpentine. 

What are its effects and uses ? 

Locally it is rubefacient. Internally it is carminative, in large 
doses causing mental exhilaration and increasing the force and 
frequency of the pulse and proving cathartic. It is eliminated by 
the lungs and kidneys, imparting a violet-like odor to the urine. 
In excessive doses it is capable of causing death (rare). The symp- 
toms of poisoning are unconsciousness, bloody, often suppressed 
urine, and rapid, feeble pulse. Vomiting and strangury or purging 
sometimes occur and occasionally the pupils are dilated. Small 
doses seem to increase the pulse rate by direct action on the heart, 
while large doses stimulate the vagi and slow the heart. Moderate 
doses are diuretic, but when large amounts are given renal irritation 
results. It is used as an alterative diuretic in chronic cystitis, gleet 
and chronic pyelitis. In impotence and spermatorrhoea depending 
on relaxation it is sometimes employed. In typhoid pneumonia and 
bronchitis, and in hypostatic pulmonary congestion, as in typhoid 
fever, it is often used externally and internally with the happiest 
effect. It is very useful in idceration of the stomach or intestines, 
and in typhoid fever when the tongue becomes brown and dry or 
cracked, red and glazed, or when the ulcers are very slow to heal ; it 
acts not only locally but also as a cardiac stimulant. In hemon-hages 
from the lungs, stomach or bowels, in post-partum hemorrhages and 
in purpura hemorrhagica it is sometimes useful. As an addition to 
stimulating enemata to cause the expulsion of flatus or to rouse the 
system to shock it is much resorted to. It is also used as an anthel- 
mintic. 

Locally as a counterirritant, either as a liniment or fomentation, 
it is much used in bronchitis and in muscular rheumatism, and in the 



216 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

latter manner in peritonitis, hysterical abdominal pains and in 
flatulency. Dose ^Uv-xv (0.3-0.9) 4 or 5 times daily in emulsion or 
capsule; as a cathartic enema or anthelmintic f^ss-j (15.0-30.0) 
may be given. Externally a liniment (linimentum terebinthino?) is 
employed, or the oil may be used either full strength or diluted with 
sweet oil. A saturated solution of camphor in oil of turpentine is 
a good rubefacient liniment. 

Oleum Terebinthin^e Kectificatum (rectified oil of turpentine), 
dose TT\,v-xxx (0.3-1.8). 

COPAIBA. 

What is copaiba ? 

Copaiba is the oleoresin of Copaiba Langsdorffii and other species 
{Nat. Ord. Leguininosse), trees of S. America. It is cathartic, 
and sometimes emetic, in large doses, slightly stimulates the circu- 
lation and acts as an alterative blennorrhetic on the mucous mem- 
branes by which it is excreted. After large doses a resinous pre- 
cipitate will occur if nitric acid be added to the urine, which, how- 
ever, is soluble in alcohol. When the resin is taken in considerable 
quantities the urine responds to the copper tests for sugar. Copaiba 
is chiefly eliminated by the genito-urinary mucous membranes and 
to a slight extent by the lungs. Its use is sometimes followed by 
urticaria. It is used in chronic genito-urinary inflammations, espe- 
cially in gonorrhoea after the subsidence of the acute stage. In 
bronchorrhcea it is sometimes employed. The oil has been lauded 
as a hydragogue diuretic in dropsies when not of renal origin. The 
dose of copaiba is Nlx-3j (0.6-3.6) or more in emulsion, pill, or 
capsule. The mass (massa copaiba? — solidified copaiba) contains 94 
per cent, with magnesia, dose gr. v-xxx (0.3-2.0) ; of the oil (oleum 
copaibce) the dose is ffiv-xv (0.3-0.9) in emulsion or capsule. 

CUBEBA— CUBEB. 

What is cubeb? 

Cubeb is the unripe fruit of Piper Cubeba (Nat. Ord. Piperacese), 
an East Indian plant. It contains a volatile oil, a neutral principle 
(cubebin) and cubebic acid. Cubeb is diuretic and carminative, 
slightly accelerating the pulse. In large doses it often causes vomit- 
ing and purging. It is eliminated by the mucous membranes and 



DIAPHORETICS. 217 

urine, increasing the excretion of uric acid. Its use is sometimes 
followed by urticaria. The addition of nitric acid to the urine after 
the use of cubeb produces a resinous precipitate. 

It is used in gonorrhoea and is less apt than copaiba to disorder 
the digestion. It is also used in bronchitis, and has been smoked in 
cigarettes to relieve sore throat and hoarseness. The powder, used 
as a snuff, is employed in coryza. The dose of powdered cubeb is 
5ss-iij (2.0-11.6); of the oil [oleum cubebcv) n\,x-xv (0.6-0.9) gradu- 
ally increased. It is not as efficacious as the oleoresin (oleoresina 
cubebo?), dose tt\,v-xxx (0.3-2.0) given in emulsion. Of the tincture 
(tinctura cubebce) the dose is f3j-ij (4.0-8.0); of the fluid 'extract 
(extraction cubeboe fluidum) f3ss-j (2.0-4.0). The troches (trochisci 
cubeba?) each contain gr. ss (0.04) of the oleoresin. 

MATICO. 

What is matico ? 

Matico is the leaves of Piper angustifolium {Nat. Ord. Piper- 
acese), a shrub of Peru. It contains a volatile oil. resin, artanthic 
and tann ic acids, etc. It is used as an alterative blennorrhetic in gonor- 
rhoea, as a hemostatic in internal hemorrhages, and locally as a 
styptic. Dose of the fluid extract (extractum matico) f3ss-j (2.0- 
4.0); of the tincture [tinctura matico) f3j-ij (4.0-8.0). 

CANTHARIS — C ANTHARIDES . 

Is cantharides used as an alterative diuretic ? 

Cantharides is an intense stimulant and irritant to the kidneys, 
being diuretic in small doses, and frequently causing strangury, pri- 
apism and bloody urine. It is sometimes used in gleet, and in sper- 
matorrhoea and impotence from weakness. It will be noticed at 
length under " Epispastics." Dose of the tincture {tinctura can- 
tharidis) gtt. v-x (0.3-0.6) t. i. d. 



ORDER II.— Diaphoretics. 

What are diaphoretics ? 

Diaphoretics are medicines which increase the secretion of sweat, 
either by (1), stimulating the secretory nerve fibres in the glands; 
(2) stimulating the nerve centre governing the secretion of sweat ; 



218 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

or (3) relaxing the skin, dilating the blood vessels and regulating the 
force of the circulation. 

For what purposes are they used and how are they classi- 
fied? 

They are used (1) to abort an oncoming disease (as a catarrh or 
inflammation of mucous or serous membranes after exposure to 
cold) or aid in its subsidence (as in the paroxysm of a malarial fever) ; 
(2) to aid absorption, as in dropsies, and (3) to eliminate poisons 
from the blood. 

They are divided into Nauseating, Sedative, Saline and Special 
Diaphoretics. 

Nauseating Diaphoretics. 
What are the nauseating diaphoretics ? 

The act of emesis is accompanied by general relaxation and dia- 
phoresis, and even in nausea a more or less pronounced perspiration 
occurs. Any of the emetics in doses just sufficient to nauseate will 
produce this effect, but the only one which is in general use for this 
purpose is Ipecac (v. " Emetics"), which is used either alone (in 
doses of gr. ss-j every two hours) or combined with opium in the 
form of Dover's Powder (v. " Opium") in the early stages of 
inflammations, in "cold" in muscular rheumatism and in acute 
suppression of the menses to break up the train of morbid symp- 
toms. 

Sedative Diaphoretics. 

What are sedative diaphoretics ? 

When the circulation is much excited, as in fevers and inflamma- 
tions generally, medicines which tend to reduce the force and rapid- 
ity of the circulation and to lower the temperature, act as diapho- 
retics. Many of these agents (particularly antimonials, aconite and 
veratrum viride) tend to nauseate or even to cause vomiting when 
given in full doses. In sthenic inflammations the ANTIMONIAL PRE- 
PARATIONS (q. v. ) especially if combined with minute doses of mor- 
phine are often very efficacious, and may be used in the early stages 
of laryngitis and bronchitis and in combination with other remedies 
in fever. Aconite and Veratrum Viride are also sometimes 
resorted to in the early stages of sthenic inflammations for their com- 



DIAPHORETICS — SriRIT OF NITROUS ETHER. 219 

bined sedative and sudorific effect. In this group also should be 
placed salicylic acid and other antipyretics {q. v.) which pro- 
duce more or less profuse perspiration. 



Saline Diaphoretics. 
What are the saline diaphoretics ? 

While some of the saline diaphoretics have a sedative effect upon 
the circulation, which is not, however, as marked as the remedies of 
the preceding group, they have no tendency to nauseate even when 
given in large doses, on the contrary, they are acceptable to the 
stomach, and form the basis of most fever mixtures. 

Potassium Citrate and its preparations have been noticed 
among the ' l Diuretics. ' ' 

LIQUOR AMMONII ACETATIS— SOLUTION OF AMMONIUM ACETATE. 

What is the solution of ammonium acetate ? 

The solution of ammonium, acetate or spirit of mindererus is a 
mild stimulant, diaphoretic and diuretic, often employed in febrile 
and inflammatory affections combined with other remedies. Dose 
fgss-j (15.0-30.0) 

SPIRITUS ^THERIS NITROSI— SPIRIT OF NITROUS ETHER. 

What is this substance ? 

Spirit of nitrous ether, or sweet spirit of nitre, is a solution of 
about 4 per cent, of nitrous ether (ethyl nitrite) in alcohol. In 
small doses it is a diaphoretic and stimulant, in larger doses an anti- 
spasmodic, and (if the skin be kept cool) diuretic ; in excessive doses, 
either internally or when inhaled, it is a depresso-motor, acting sim- 
ilarly to the other nitrites (q. v. ) and capable of causing death. It 
is much used as a diaphoretic in fevers, and occasionally as a diuretic 
(q. v.) and antispasmodic in nervous children. Dose for an adult 
f3j-iv (4.0-15.0). It is given as a diaphoretic in minute doses, 
frequently repeated and largely diluted, the body being kept 
warm. 



220 essentials oe materia medica and therapeutics. 
Special Diaphoretics. 

pilocarpus. 
What is pilocarpus ? 

Pilocarpus or Jaborandi is the leaflets of P. Selloanus (Rio de 
Janeiro Jaborandi) and of P. Jaborandi (Pernambuco Jaborandi) 
(Nat. Ord. Rutacese), a Brazilian shrub. 

What are its chief chemical constituents ? 

It contains an alkaloid, pilocarpine, and a volatile oil ; a second 
alkaloid, jaborine, probably a derivative of pilocarpine, has been 
isolated, and lately two other derivative alkaloids pilocarpidine and 
jaborandine have been described. 

What are the physiological effects of these substances ? 

In medicinal doses pilocarpus or pilocarpine produces profuse 
diaphoresis and salivation, sometimes copious, with flushed face and 
quickened circulation and respiration. Sometimes the mucous 
secretions are increased also, and nausea, even vomiting, may occur. 
It increases both the watery portion and the solids (especially urea) 
of the perspiration by a direct influence on the nerve endings gov- 
erning its secretion, and probably increases the secretion of the gastric 
juices and bronchial mucus in the same manner. It appears to act 
directly as a stimulant upon the cells of the salivary glands. There 
seems to be some relation between its influence over the secretions of 
perspiration and saliva, the one being more profuse when the other 
is scanty, and vice versa. In small doses frequently repeated it proves 
diuretic. It seems to stimulate the nutrition of the hair. The car- 
diac action is at first quickened, but soon slowed, and the arterial 
tension is elevated. Applied to the eye it contracts the pupil (by 
peripheral action) and increases the tension of accommodation. Pi- 
locarpine and atropine are antagonists as regards their action on the 
heart, intestines and pupil, and on the secretions of perspiration and 
saliva. Jaborine acts upon the heart, pupil, intestines and salivary 
glands like atropine. Pilocarpidine causes profuse diaphoresis, sali- 
vation, vomiting and purging; while jaborandine resembles atropine 
in its cardiac effects. 

What are the medicinal uses of pilocarpus and its alkaloid ? 

Pilocarpus or pilocarpine is used as a diaphoretic to abort disease 



SEDATIVE EXPECTORANTS. 221 

in incipient catarrh and at the onset of a paroxysm of malarial fever ; 
in various forms of dropsy, to aid in removal of the fluid, especially 
hydrothorax, and in pulmonary oedema; in uraemia, to eliminate 
the poison from the blood, it is of great value, and similarly in acute 
or chronic Bright 's disease, to relieve the kidneys of some of their 
work, it is very useful. It is also employed in subacute and muscular 
rheumatism. 

As a diuretic, minute doses (pilocarpine gr. ^ (0.005), are given in 
acute suppression of urine, but when thus used in the early stages of 
acute desquamative nephritis it must be employed with great caution. 
As an expectorant it has been given in bronchitis and asthma and, 
with varying success, in croup and diphtheria. To stimulate the 
growth of hair in alopecia, pilocarpine may be administered inter- 
nally or hypodermically, and applied locally as well, and it has been 
employed hypodermically with success to arrest severe and prolonged 
hiccough. 

It should not be given in diseases of the gastro-intestinal mucous 
membrane, nor in weak heart due to cardiac disease. 

What are the officinal preparations of pilocarpus and their 
doses? 

Extractum Pilocarpi Fluldum (fluid extract of pilocaipus), 
dose f&s-j (2.0-4.0). 

Pilocarpine Hydrochloras (pilocarpine hydrochl orate), dose 
gr. i-ss (0.008-0.032). It is well adapted to hypodermic use. 



ORDER III.— Expectorants. 

What are expectorants ? 

Expectorants are remedies which are given to modify the secre- 
tions of, and promote their expulsion from, the air passages. 

How may they be classified ? 

They are divided into sedative and stimulating expectorants ? 

Sedative Expectorants. 

What are sedative expectorants ? 

They are remedies which increase the secretion and at the same 



222 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

time tend to lower the blood pressure, cause nausea and, if fre- 
quently repeated, vomiting. 

Name the sedative expectorants. 

Ipecac, apomorphine, tartar emetic, pilocarpine, lobelia and 
grindelia. Of these ipecac and apomorphine have been discussed 
with the "emetics," tartar emetic with the "sedatives," pilocarpine 
with the "diaphoretics," and lobelia with the " depresso-motors." 

GRINDELIA. 

What is grindelia? 

Grindelia is the leaves and flowering tops of Gr. robusta and G. 
squarrosa {Nat. Ord. Composite ). It appears to depress the motor 
nerves and muscles, and in large doses to slow the heart and reduce 
the blood-pressure. Toxic doses produce narcosis with dilated 
pupils. It is eliminated by the kidnej^s, increasing the flow of 
urine, and to some extent by the broncho-pulmonary mucous mem- 
brane. It has been highly recommended in spasmodic and car- 
diac asthma, in hay asthma and hay fever, in whooping-cough and 
in acute and chronic bronchitis. In chronic cystitis it has been 
advantageously employed, and as a local application in vaginitis 
and in poisoning by rhus toxicodendron has met with some success. 
Dose of the fluid extract {extractum grindelice fluidum) TT\,x-f3j 
(0.6-4.0). 



Stimulating Expectorants. 
What are stimulating' expectorants ? 

They are remedies which probably modify the secretion by toning 
up the broncho-pulmonary mucous membrane through which they 
are eliminated. Most of them seem to exert an alterative effect in 
passing through the membrane, and many of them elevate the 
arterial tension. 

Name the stimulating expectorants. 

Ammonium chloride, senega, quillaja, quebracho, asclepias, erio- 
dictyon, garlic, sanguinaria, ammoniac, benzoin, Peruvian balsam, 
balsam of Tolu, squill, eucalyptus, serpentaria, turpentine, tar, terpin 
hydrate, and terebene. 



EXPECTORAN'IS— SENEGA. 223 

AMMONII CHLORIDUM — AMMONIUM CHLORIDE. 

What is ammonium chloride ? 

Ammonium chloride, called also ammonium muriate or sal am- 
moniac, is a crystalline salt obtained from gas liquor. 

What are its effects and uses ? 

Locally it is irritant. In medicinal doses it is believed to influence 
especially the mucous membranes, promoting very decidedly nutritive 
changes and hastening epithelial exfoliation. When given con- 
tinuously for a length of time it diminishes the solids of the blood 
and stimulates the secretions. It is supposed to stimulate the he- 
patic functions, for the amount of urea excreted is greatly increased, 
as are all the other solids of the urine except uric acid. Large doses 
are purgative. It is used as a stimulating and alterative expectorant 
in the moist stage of acute and in chronic bronchitis, in pneumonia 
and the various catarrhs of children. Abroad it is employed also in 
gastric and intestinal catarrJis, in chronic hepatitis and in the early 
stages of hepatic cirrhosis. In cases of albuminoid liver, spleen or 
kidneys it is very useful. In subacute muscular rheumatism and in 
neuralgia, especially ovarian, it is advantageous, and it has been used 
internally as an alterative and employed locally as a sorbefacient 
in scrofulous adenitis of the cervical glands, and uterine fibroid 
tumors. 

Dose gr. x-xxx (0.6-2.0). The unpleasant taste may be partially 
disguised by liquorice. The troches (trochisci ammonii chloridi) 
each contain about gr. ij (0.1) of the salt. 

SENEGA. 

What is senega? 

Senega is the root of Polygala Senega or senega snake-root {Nat. 
Ord. Polygaleae) and contains polygalic acid or senegin, a glucoside 
identical with saponin. 

What are its effects and uses ? 

Locally, it is an irritant. Internally, it stimulates the mucous 
membranes, and in large doses is emetic and cathartic. It is given 
as a stimulating expectorant in the latter stages of acute and in sub- 
acute and chronic bronchitis, especially when the mucous membranes 
are wanting in tone. It has also been used as an emnienagogue in 



224 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

amenorrhea and as a diuretic in dropsies. Dose of the fluid extract 
{extractum senegee fluidum) Tn,x-xx (0.6-1.2) ; of the syrup {syrupus 
senega?) f3j-y (4.0-8.0). It is an ingredient of the compound syrup 
of squill. 

QUILLAJA. 

What is quillaja? 

Quillaja, or soap-bark, is the inner bark of Q. Saponaria {Nat. 
Ord, Rosaceae), a S. American tree, containing saponin, which 
foams like soap when in infusion. Locally, saponin is an irritaut 
and protoplasmic poison. Given internally in sufficient doses it is 
a nerve and muscle poison, and completely antagonizes the effects 
of digitalis on the heart, which it paralyzes in diastole. It increases 
the secretion of bronchial mucus. Quillaja has been used as an 
expectorant in chronic bronchitis, emphysema, and dilated bronchi. 
It is also used to aid in emulsifying oils. Dose of the tincture (tinc- 
tura quillaje) n\,xv-xxx (0.9-2.0). 



ASPIDOSPERMA. 

What is aspidosperma ? 

Aspidosperma, or Quebracho, is the bark of A. Quebracho-blancho 
{Nat. Ord. Apocynaceae). It contains 5 alkaloids, aspidospermatine 
(which is believed to represent the entire virtues of the bark), and 
aspidospermine, quebrachine, hypoquebrachine, and quebrachamine. 
It has been used in dyspnea independent of cause, but as it appears 
to have no action on the heart or kidney it probably is of service 
only in bronchial asthma and emphysema. It has also been used 
as a bitter tonic. Dose of the fluid extract {extractum aspidosper- 
matisfluidum) TT\,xv-f£>j (1.0-4.0). 



ASCLEPIAS. 

What is asclepias ? 

Asclepias, or pleurisy root, is the root of A. tuberosa {Nat. Ord. 
Asclepiadeae). It is an expectorant, diaphoretic, and diuretic, and 
causes considerable cardiac depression. In large doses it is a gastro- 
intestinal irritant. It is but little used. Dose of the fluid extract 
{extractum asclepiadis fluidum) tt\,xv-xxx (1.0-2.0). 



EXPECTORANTS — SANGUINARIA. 225 

ERIODICTYON. 

What is eriodictyon ? 

It is the leaves of E. glutinosum, or California tar-bush [Nat. Orel. 
Hydroph3 r llaceae). and is known also as yerba, santa. It is used as 
an expectorant in chronic pulmonary disorders, and as a vehicle (in 
the form of elixir) to disguise the taste of quinine and other bitter 
drugs. Dose of the fluid extract (extr actum eriodictyi fluidum) 
nixx-f3j (1.2-4.0). 

ALLIUM — GARLIC. 

What is garlic ? 

Garlic is the bulb of Allium sativum (Nat. Ord. Liliaceae) and 
contains a very volatile oil. Locally applied it is a rubefacient. 
Taken internally it is a condiment, stimulating digestion, increasing 
the secretions generally, especially the broncho-pulmonary, and 
quickening the circulation. It is used as a stimulating expectorant 
in subacute and chronic bronchitis and in acute bronchitis of infants, 
especially when the disease begins to assume the capillary form. 
Externally it is used as a counter-irritant in the above diseases, and 
in infantile convulsions, applied to the spine, legs and feet in the 
form of a poultice. Dose of the syrup [syrupus allii) f3j (4.0) for 
a child. 

SANGUINARIA. 

What is sanguinaria ? 

Sanguinaria or blood-root, the rhizome of S. canadensis (Nat. 
Ord. Papaveracese), contains an alkaloid, sanguinarine. It is a 
local irritant. Large doses cause vomiting with great depression, a 
slow, irregular pulse (from direct action on the heart) and lowered 
blood-pressure, dilated pupil, collapse and death from paralysis of 
the respiratory centre, sometimes preceded by convulsions of spinal 
origin and lowered reflex activity. Moderate doses increase the 
arterial pressure from stimulation of the vaso-motor centres, which 
are paralyzed by larger doses. It stimulates the liver, the mucous 
membranes and the salivary and intestinal glands. It is used chiefly 
as a stimulating expectorant in lingering cases of bronchitis. Dose 
of the tincture (tinctura sanguinaria?) tt^v-xxx (0.3-2.0); of the 
fluid extract (extractum sanguinarice fluidum) TTlij-v (0.12-0.3). 
Sanguinarine (not official) has also been used as an expectorant in 
the dose of gr. ^i (0.005-0.008). 
15 



226 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
AMMONIACUM— AMMONIAC. 

What is ammoniac ? 

Ammoniac is a gum-resin obtained from Dorema Ammoniacum 
(Nat Ord. Unibelliferge). It is used internally as a stimulating 
expectorant in chronic bronchitis and in bronchorrhoea, and locally as 
a counter irritant. Dose gr. x-xxx (0.6-2.0) ; of the emulsion 
(emulsum ammoniaei— formerly called the mixture, Pharm. 1880) 
f£ss (15.0). A plaster is official (emplastrum ammoniaei cum 
hydrargyro — plaster of ammoniac with mercury). 



BENZOINUM — BENZOIN. 

What is benzoin? 

Benzoin, a balsamic resin obtained from Styrax Benzoin, or Ben- 
jamin tree (Nat, Ord. Styraceae) contains benzoic acid, resin, volatile 
oil, and often cinnamic acid. 

The effects of benzoin are due to benzoic acid (v. "Antiseptics"). 
Locally it is an irritant. Internally it stimulates the broncho-pul- 
monary and genito-urinary mucous membrane. It is eliminated 
chiefly by the urine as hippuric acid, increasing the acidity of that 
excretion. 

It is chiefly used by inhalation (compound tincture 5j(4.0), in a 
cupful (120.0) of boiling water,) in laryngitis, or to quiet spasmodic 
laryngeal cough, as in influenza. It has also been employed inter- 
nally in chronic bronchitis and in chronic cystitis with alkaline urine 
and phosphatic dep>osits, but for the latter purpose benzoic acid or 
its salts are preferred. It is added to ointments to prevent rancid- 
ity, and is much employed in the form of fumigating pastilles. It 
is also used locally as an antiseptic and protective {compound tincture) 
in fissured nipple, chapped, hands, and fissure of the anus, and has 
even been employed as a substitute for carbolic and salicylic acids, 
for its antiseptic effects, in the treatment of wounds. Dose of the 
tincture (tinctura benzoini) f^ss-j (2.0-4.0) ; of the compound tinc- 
ture (tinctura benzoini composite:) f^ss-ij (2.0-8.0). 

Benzoinated lard (adeps benzoinatus) contains 2 per cent, of 
benzoin. 



EXPECTORANTS — TAR. 227 

BALSAMUM PERUVIAN UM— BALSAM OF PERU. BALSAMUM TOLU- 
TANUM — BALSAM OF TOLU. 

What are these substances ? 

Balsam of Peru is a balsam obtained from Toluifera Pereirge 
{Nat. Orel. Leguminosse), and contains cinnamein, resin, benzalco- 
hol, benzylic benzoate. stilbene, and cinnamic and benzoic acids. 

It is a stimulant and tonic to the mucous membranes, and has 
been used in various catarrhs. Dose f£ss (2.0) in emulsion. 

Balsam of Tolu is a balsam obtained from Toluifera Balsamum 
(Nat. Ord. Leguminosse) and contains resins, benzylic benzoate and 
cinnamate, tolene, and cinnamic and benzoic acids. Its effects and 
uses are similar to those of balsam of Peru, to which it is preferred 
because of its more pleasant taste. Dose gr. x-xxx (0.6-2.0) in 
emulsion, every few hours. It is, however, principally used as a 
vehicle. Dose of the tincture (tiuctura tolutani) is f3j-ij (4.0-8.0) ; 
of the syrup {syrupus tohitanus) f3j-iv (40-15.0). It is also an 
ingredient of the compound tincture of benzoin. 



PIX LIQUIDA— TAR. 

What is tar ? 

Tar is an empyreumatic oleoresin obtained by destructive distilla- 
tion of the wood of Pinus palustris and other species of P. {Nat. 
Ord. Coniferae). When distilled it yields pyroligneous acid, oil of 
tar, and a black residuum known as pitch. The oil of tar contains 
creasote. Tar resembles turpentine in its effects on the mucous 
membranes, but is more antiseptic. Externally it is an irritant. It 
is used as a stimulating expectorant in the later stages of acute, 
bronchitis, particularly where the disease does not yield readily 
to other treatment, and in chronic bronchitis. Externally it is 
employed in chronic skin diseases, especially in squamous affec- 
tions. 

Tar-water (not official) may be given in doses of f^ss-j (15.0-30.0) 
or the syrup {syrupus picis liquidce), which is better, in doses of 
f^ss (15.0). Locally, the oilipleum picis liquidce) is used as a sub- 
stitute for "oil of cade " {oleum cadinum), which is also official, or 
the ointment (unguentum picis liquidce) may be applied. 



228 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
TERPINI HYDRAS — TERPIN HYDRATE. 

What is terpin hydrate ? 

It is the hydrate of the diatomic alcohol terpin. It occurs in 
colorless, rhombic, lustrous prisms; is odorless, but has a slightly 
aromatic, rather bitter taste. 

It acts on the nervous system and on mucous membranes in a man- 
ner similar to turpentine. It is eliminated by the urine, to which it 
imparts a turpentine odor. When given in large doses or for a long 
time, it may cause strangury, albuminuria, or even hsematuria. 

From its stimulating influence on mucous membranes it has been 
much used as an expectorant in bronchitis, either acute or chronic, 
especially when the secretion is very free. 

It has also been used in cystitis, in gonorrhoea, and in chronic 
kidney disease. Dose gr. j-iij (0.06-0.2) every 4 hours, in pill or 
capsule. 

TEREBENUM— TEREBENE. 

What is terebene ? 

Terebene is a liquid consisting chiefly of pinene, and containing 
not more than very small proportions of terpinene and dipentene, 
and is prepared by gradually adding sulphuric acid to the oil of tur- 
pentine. In its general effects it resembles turpentine. It is a good 
stimulating expectorant, very useful in the declining stages of acute 
and chronic bronchitis. It is also useful in emphysema, phthisis, and 
pleurisy. In fetid bronchitis and bronchiectasis it is very efficacious. 
It has also been employed in flatulent dyspepsia and genito-urinary. 
inflammations. Dose ntv-xx (0.3-1.2) in capsule or emulsion 
t. i. d. , or its vapor may be inhaled diluted with steam. 

What substances are often used as expectorants which have 
been previously considered in other medicinal groups ? 

Squill and turpentine [v. u Diuretics"), eucalyptus, serpentaria. 
and Prunus Virginiana (v. " Aromatic Bitters"). 

ORDER IV.— Astringents. 

What are astringents ? 

Astringents are remedies employed to cause contraction of the 
tissues with which they come in contact and thus lessen secretion. 



ASTRINGENTS— TANNIC ACID. 229 

For what purposes are they used ? 

They are used to check profuse secretion (e. g., ptyalism, etc.) or 
morbid discharges (e. #., diarrhoea), to overcome relaxation of the 
tissues, and as haemostatics and styptics. 

How may the astringents be classified ? 

They are divided into vegetable and mineral astringents. 

Vegetable ' Astringents. 

What are the vegetable astringents ? 

They are tannic and gallic acids, and the various plants which are 
used as astringents on account of containing these principles. 

Name the vegetable astringents. 

Tannic acid, gallic acid, nutgalls, catechu, kino, krameria, haerna- 
toxylon, white-oak, geranium, witch-hazel, red and white rose, 
sumach, chestnut leaves. 

ACIDUM TANNICUM — TANNIC ACID. 

What is tannic acid? 

Tannic acid (gallo-tannic acid — digallic acid) is an organic acid 
obtained from nutgall. It is widely distributed throughout the 
vegetable kingdom and exists under two forms, gallo-tannic acid 
(which is the official variety and strikes a blue-black color with the 
ferric salts) and kino-tannic acid (which produces a greenish-black 
color with the same salts). Gallo-tannic acid is a light yellowish, 
amorphous powder, usually cohering in the form of glistening scales 
or spongy masses, without smell, but having a strongly astringent 
taste. 

It is freely soluble in water and in alcohol, and may readily be 
dissolved in glycerin by the aid of moderate heat. 

What are its physiological effects ? 

Tannic acid is a powerful astringent, coagulating albumins, con- 
tracting blood-vessels and con stringing tissues with which it comes 
in contact. It checks the secretions of the alimentary canal when 
taken internally, and restrains peristalsis, thus tending to constipate. 
It is converted into an alkaline tannate and into gallic acid in the 
prima via and slowly absorbed. It is eliminated by the faeces and 
urine under its own form and as gallic and pyrogallic acids. 



230 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

For what purposes is it used in medicine ? 

When remote astringent effects are desired gallic acid is preferable, 
but tannic acid is employed whenever the part to be acted on is so 
situated that the drug can come in direct contact with it. Thus, 
it is given to arrest morbid discharges from the bowels in diarrhoea 
and dysentery \ both internally and by enema, and is used externally 
for the same purpose in leucorrhoea, gleet, colliquative sweating, and 
as an application to chronic ulcers. To counteract relaxation of 
tissues it is employed in the treatment of spongy gums, chronic pha- 
ryngitis and laryngitis, mercurial stomatitis and hemorrhoids. It 
is used also to arrest hemorrhages from the nose, gums, pharynx, 
stomach and bowels, and locally as a styptic ; to harden tissues sub- 
jected to pressure, as in threatened bed-sores and tender feet, and 
as an antidote to antimony and other metallic poisons. 

Dose, in diarrhoea, gr. j-xv (0.06-1.0) in pill ; in hemorrhage, gr. 
v-xx (0.3-1.3) in powder. The troches (trochisci acidi tannici) each 
contain gr. j (0.06), and may be used in relaxed palate or sore throat. 

The ointment (unguentum acidi tannici) or the glycerite (glyceritum 
acidi tannici), a solution in glycerin, may be used locally. 



ACIDUM GALLICUM— GALLIC ACID. 

What is gallic acid ? 

Gallic acid is an organic acid, usually prepared from tannic acid, 
and is tannic acid -f- a molecule of water ; thus, HC u H 9 9 (tannic 
acid) +3H 2 = 2(HC 7 H 5 5 +H 2 0) (gallic acid). It occurs as 
white or pale fawn-colored, silky, interlaced needles or triclinic 
prisms ; odorless, having an astringent or slightly acidulous taste. 
It is very soluble in boiling alcohol and boiling water, less so in 
cold alcohol, glycerin, ether, or cold water. It does not coagulate 
albumin, and hence is not as efficacious as a local astringent, but is 
preferred to tannic acid when it is desirable that the astringent should 
be absorbed and act through the blood on some remote part. It is 
used as a hemostatic in hemoptysis, hematuria, and uterine hemor- 
rhage. It is also employed to lessen secretion, as in colliquative sweats 
and bronchorrhoea , and to check morbid discharges, as in chronic albu- 
minuria. Dose gr. v-xxx (0.3-2.0), in powder, pill, or solution. 



ASTRINGENTS — KRAMERIA. 231 

Describe the preparations, doses, and uses of the vegetable 
astringents which owe their virtues to tannic and 
gallic acids. 
Galla {nut gall) is an excrescence found on Quercus lusitanica, 
the gall oak {Nat. Orel Cupuliferas) caused by the punctures and 
deposited ova of a fly (Cynips Quercus folii or Diplolepis Gallae tinc- 
toriae). Before the maturity of the larvae and their escape from 
the gall, they contain tannic acid (50-60 per cent.) and gallic acid 
(3 per cent.); afterward they are much inferior and contain compar- 
atively little of these substances. 

They are but little used except as the source of tannic and gallic 
acids. The tincture {tinctura gallee) is chiefly used as a chemical 
test. The ointment {unguentum gallee) combined with powdered 
opium is sometimes applied to hemorrhoids. 

Catechu, an extract prepared from the ivood of Acacia Catechu 
{Nat. Orel. Legnminosae), contains kino-fannic and catechuic acids 
[catechin). It is a powerful astringent, much used in diarrhoeas 
and to some extent in hemorrhages, and locally as an astringent in 
sore throat, as an injection in gonorrhoea, and leucorrhcea, and as a 
styptic. Dose gr. x-xxx (0.6-2.0) in emulsion or capsules. Of the 
compound tincture {tinctura catechu composita) f3j-iij (4.0-12.0) 
may be given. The troches {trochisci catechu) each contain gr. 
j (0.06). 

Kino, the inspissated juice of Pterocarpus Marsupium{i\W. Ord. 
Legnminosae) and other trees; contains Mno-tannic acid, hino'in, 
pyrocatechin, etc., and has similar properties and uses to catechu. 
Dose of the powder gr. x-xxx (0.6-2.0); of the tincture [tinctura 
kino) f3j-ij (4.0-8.0). 

Krameria, the root of K. triandra and of K. Ixina [Nat Ord, 
Polygaleae), S.American shrubs; contains hramero-tannic add, and 
is a powerful astringent, similar to kino and catechu. Dose of the 
extract [extractum kramen'ce) gr. v-xv (0.3-1.0) ; of the fluid extract 
[extractum hramerias, flw'dum) f,3ss-j (2.0-4.0) ; of the tincture 
[tinctura krameria) foss-ij (2.0-8.0); of the syrup (syrupus 
hramerue) f3j-jv (4.0-15.0). The troches {trochisci kramerice) each 
contain gr. j (0.06). 



232 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

H^ematoxylon, logwood or Cam peachy wood, is the heart wood 
of H. campeachianum {Nat. Ord. Leguminosae), containing tannic 
acid, hamiatoxylin, etc. It is a good astringent in diarrhoeas due to 
relaxation, especially in children, but the discharges will stain the 
linen blood-red. Of the extract (extraction hwmatoxyli) the dose is 
gr. x-xxx (0.6-2.0). 

Quercus Alba, or white oak (Nat Ord. Cupuliferae). The 
bark is official, and contains querci-tannic acid. It is occa- 
sionally used in diarrhoeas, but more often as an enema in hemor- 
rhoids and prolapsus ami, or as a vaginal wash in leucorrhcea or 
relaxed conditions with tendency to cystocele or rectocele. It makes 
an indelible stain on linen. 

Geranium, the rhizome of G. maculatum, crow's foot or crane's 
bill (Nat Ord. Geraniaceae) ; contains tannic and gallic acids, and 
is an efficient indigenous astringent. Dose of the fluid extract 
(extractum geranii fluidum) f 3ss-j (2.0-4.0). 

Hamamelis, the leaves of H. virginica or witch hazel {Nat. 
Qrd. Hamamelaceae) ;, contains tannic acid and a bitter 'principle. 
It is an astringent and seems to contract the veins of the skin and 
mucous membranes. It has been used in passive hemorrhages as a 
hemostatic, as an astringent enema in hemorrhoids, and locally in 
congestions and inflammations. Dose of the fluid extract (extractum 
hamamelidis fluidum) f 3ss-j (2.0-4.0). 

Rosa Gallic a (red rose) ; Rosa Centifolia (pale rose), (Nat. 
Ord. Rosaceae). Their petals are official. The former is a very 
mild astringent, but they are principally used as flavoring ingredients 
and vehicles. The preparations of red rose are a fluid extract (ex- 
tractum roso? fluidum), a honey (mel roso?), & syrup (syrupus rosa?) 
and a confection (confectio roso?) ; those of pale rose are a triple or 
stronger rose water (aqute rosai fortior), and another milder water 
(aquae, rosce) from which is made an ointment (unguentum aquos 
rosm — cold cream). 

Rhus Glabra (sumach) (Nat. Ord. Anacardieae). The fruit 



ASTRINGENTS— LEAD. 233 

is official. It is a good astringent in sore mouth and pharyngitis. 
The Jiu id extract [extractum rho'is glabrae fluidum) may be diluted 
with two or more parts of water and used as a gargle. 

Castanea, the leaves of C. dentata or chestnut [Nat. Ord. Cupuli- 
ferae), is astringent and supposed to possess antispasmodic prop- 
erties. It is chiefly used in whooping-cough. Dose of the fluid 
extract {extractum castanece fluidum) f3ss-ij (2.0-8.0). 

Mineral Astringents. 

Name the mineral astringents. 

Most of the metallic salts possess astringent properties, but those 
especially used for this purpose are the lead salts ; alum ; aluminium 
sulphate ; the salts of copper, of zinc, of silver, and of bismuth ; and 
cerium oxalate. 

PLUMBUM — LEAD. 

What is the source of lead ? 

Lead is obtained by roasting galena, the native sulphide. 

What are its physiological actions ? 

Metallic lead is inert, as are probably also the sulphide and sul- 
phate. All other salts of lead, when applied locally in solution, are 
astringent, or if the solution be strong, irritant. In medicinal doses 
they are astringent to the alimentary canal, decreasing its secretions 
and also the secretion of bile. They are but slowly absorbed. When 
taken for some time they reduce the volume and frequency of the 
pulse by stimulation of the cardio-inhibitory centre and the periph- 
eral filaments of the vagi. They are eliminated by the liver and 
kidneys. 

What are its toxicological actions ? 

In large doses several of the lead salts are capable of causing acute 
poisoning, the symptoms being intense gastro-intestinal irritation, 
vomiting, coma, paralysis and collapse. 

Chronic poisoning is caused by saturation of the system with lead, 
either by drinking pure water conveyed in lead pipes (the contained 
air forming a soluble oxide), constantly eating substances adulterated 
with lead salts, exposure in lead factories, etc. Lead colic (or 



234 ESSENTIALS OP MATERIA MEDICA AND THERAPEUTICS. 

painters' colic), the most common form, consists of sharp pains about 
the umbilicus, obstinate constipation, hard, contracted abdomen, 
and often nausea and vomiting. This is probably due to intense 
stimulation of the intestinal ganglia by the lead, causing arrest of 
peristalsis and spasm of the muscular coat of the bowel. It is 
quickly relieved by belladonna, atropine or pilocarpine. Sometimes 
the poisoning takes the form of lead-arthralgia, manifesting itself 
by severe pain in the joints and limbs, and cramps. 

Lead paralysis is loss of voluntary motion in groups of muscles, 
particularly the flexors of the upper extremity, causing vrrist-drop. 
Electro-muscular contractility is affected, the muscles waste, and 
often anaesthesia of the affected or opposite side is present. The 
poison may also affect the brain, kidney, or other organs. An im- 
portant symptom of lead poisoning is a blue line upon the gums 
where they join the teeth, and in case of doubt lead may be detected 
in the urine by the chemical tests. 

What are the tests for lead, and how should saturnine poi- 
soning be treated? 

Sulphuretted hydrogen gives a black, and a solution of potassium 
iodide a yellow precipitate with soluble lead salts. The treatment of 
acute poisoning consists in evacuating the contents of the stomach, 
and administering diluted sulphuric acid, or sodium or magnesium 
sulphate as a chemical antidote. In chronic poisoning, discover its 
source and remove it (in the case of painters, insist on scrupulous 
cleanliness of the hands and nails, and the use of very diluted sul- 
phuric acid as a drink) ; give purgatives to overcome the resulting 
constipation ; give diluted sulphuric acid or the soluble sulphates, 
with baths of potassium sulphide as antidotes, and aid elimination 
by large quantities of diluents and potassium iodide. In lead colic 
atropine is of service, and in lead palsies electricity (the faradaic 
current when the muscles respond) and strychnine are advantageously 
employed. 

For what medicinal purposes are the lead salts used? 

They are used internally as astringents in diarrhoeas and dysen- 
teries, as hemostatics, and in the treatment of internal aneurism. 
Locally, as astringent injections in leucorrhcea and gonorrhoea, and 



ASTRINGENTS — LEAD. 235 

us sedative and astringent lotions in inflammations. The acetate is 
the only lead salt which is administered internally. 

What are the preparations of lead and their nses ? 

Plumbi Oxidum (lead oxide), or litharge, is occasionally used as 
a dusting powder for ulcers, but is chiefly employed to make a 
plaster (emplastrum plumbi), which is the basis for most officinal 
plasters ; diachylon ointment (unguentum diachylon), useful in skin 
diseases, and soap-plaster (emplastrum saponis). 

Plumbi Acetas (lead acetate), or sugar of lead, is used internally 
as an astringent in diarrhoea, often combined with opium, and is 
also useful in dysentery. To lessen the expectoration in chronic 
bronchitis and to check the night sweats of phthisis it is sometimes 
given. As a hemostatic in yellow fever it does some good, and 
perhaps also in hemoptysis. It has been employed as a sedative in 
the treatment of internal aneurism. Locally as a sedative and 
astnngent lotion it is much used in inflammations (not applicable to 
ocular therapeutics, as it may cause corneal opacity), and to check 
morbid discharges. Dose gr. j-viij (0.06-0.5) two or three times 
a day. As an injection in gonorrhoea gr. ss-ij (0.03-0. 1 2)— f 3 j (30.0) ; 
as a lotion in inflammation gr. v-x (0.3-0.6)-t3J (30.0). 

Liquor Plumbi Subacetatis (solution of lead subacetate — 
1 Goulard's extract) contains about 25 per cent, of lead subacetate in 
solution, and is used externally and in the preparation of lead water 
(liquor plumbi subacetatis dilutus — diluted solution of lead subacetate), 
which contains 3 per cent, of the stronger solution ; and of Goulard' ' s 
cerate (ceratum plumbi subacetatis — cerate of lead subacetate). 

Plumbi Iodidum (lead iodide). It may be used internally, dose 
gr. ij-iij (0.13-0.19), but is chiefly employed externally in the form 
of ointment (unguentum plumbi iodidi), which contains 10 per 
cent, of the salt. 

Plumbi Nitras (lead nitrate) is used as a disinfectant (Ledoycu's 
disinfecting fluid contains 3j to the f.fj — about 4.0 to 30.0), astrin- 
gent and sedative, in wounds, ulcers, cracked nipples, on}T-hia 
maligna, etc. 

Plumbi Oarboxas (lead carbonate — white lead) is used chiefly as 
an application to fresh burns. If applied to a large surface, care 



236 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

should be taken to guard against poisoning. An ointment [unguen- 
tum plumbi carbonatis) is official, and contains 10 per cent, of the 
carbonate. 



ALUMEN— ALUM. 

What is alum ? 

Official alum is a double sulphate of aluminum and potassium. 
There are other varieties in which potassium is replaced by some 
other base, as ammonium or sodium. 

What are its effects and uses ? 

Alum is a powerful astringent, and in large quantity an irritant, 
whether used locally or internally. In large doses it is emetic, and in 
excessive doses has caused death from gastro-intestinal irritation. It 
is used in solution as an astringent, by atomization in bronchorrhasa, 
by injection in leucorrhoza, gonorrhoea and gleet, as a gargle in sore- 
throat, relaxed palate and uvula, as a lotion in conjunctivitis and 
on cotton as a tampon in cystocele, rectocele and uterine prolapse. 
As a hemostatic in hemoptysis, a saturated solution may be used by 
atomization ; and as a styptic [aqua pagliari consists of alum, com- 
pound tincture of benzoin and water boiled together) it is employed 
locally to arrest hemorrhage. As an emetic it is used in croup in 
capillary bronchitis and as an adjuvant to other emetics. It is also 
efficient in the treatment of lead colic. Dose as an astringent gr. 
x-xxx (0.6-2.0) ; as an emetic 3j-iv (4.0-16.0). In lead-poisoning 
a teaspoonful (4.0) may be given every 3 or 4 hours. 

Dried alum (alumen exsiccation) is alum deprived of its water 
of crystallization by heat. In excessive doses it has proved fatal. 
Dose gr. v-x (0.3-0.6). Externally it is applied as a mild escharotic 
to fungous granulations. 



ALUMINI SULPHAS— ALUMINUM SULPHATE. 

What is aluminum sulphate ? 

It is a powerful astringent and antiseptic, and is employed for 
these purposes externally and as an injection in gonorrhoea. Its 
solution has been used to preserve cadavers for dissection. 



ASTRINGENTS— COPPER. 237 

CUPRUM— COPPER. 

What are the sources and the effects of copper ? 

Copper is obtained from copper pyrites, a double sulphide of iron 
and copper. The metal itself is inert. The salts are mild astrin- 
gents and stimulants when in weak solution, and when strong, act as 
irritants; in powder they are mild caustics. Taken internally in 
small doses they are astringent, and are supposed to act as tonics to 
the nervous system. In larger doses they are local emetics. In 
excessive amounts they act as irritant poisons, causing gastrointesti- 
nal inflammation, hematuria, sometimes jaundice, convulsions, 
paralysis, delirium, coma and death. The post-mortem reveals fatty 
degeneration of the liver and decomposition of the blood corpuscles. 
When taken continuously for a very long time a condition of chronic 
poisoning results, with giddiness, occasional diarrhoea, cramps, wast- 
ing, and sometimes progressive palsies, respiratory failure and death. 
A. green line is sometimes observed on the gums. 

The tests for the soluble copper salts are potassium ferrocyanide, 
which gives a mahogany-colored precipitate ; ammonia, which gives 
a beautiful blue color, and metallic iron on which metallic copper 
will be deposited from a solution. The treatment of acute poisoning 
is albumen (milk or eggs) ; opium, demulcents and treating symp- 
toms as they arise. In chronic poisoning, endeavor to eliminate it 
as if the poison were lead. 

For what purposes is copper used in medicine ? 

It is used internally as an astringent in chronic diarrhoea, espe- 
cially when ulceration exists, as an emetic (the sulphate), especially in 
narcotic poisoning, and occasionally as a tonic in nervous debility 
and functional nervous diseases. Locally it is efficacious as a stimu- 
lant to ulcers, as an escharotic in granular conjunctivitis and flabby 
granulations, and as an astringent injection in gonorrhoea. 

What are the preparations of copper and their doses ? 

Ccpri Sulphas (copper sulphate) called also blue vitriol, or blue 
stone. Dose as an astringent gr. \-'} (0.01-0.00). in pill ; as an emetic 
gr. iij-v (0.2-0.3) ; as an injection in gonorrhoea gr. j-j (0.01-0.06) 
to fgj (30.0). 



238 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
ZINCUM— ZINC. 

What are the sources, action, uses and preparations of zinc? 

Zinc is obtained principally from the native carbonate and sulph- 
ide. The effects of the zinc salts are similar to those of copper, but 
are less powerful. In excessive doses they cause an acute poisoning 
very similar to that produced by copper, the antidotes being milk 
and eggs, alkalies and their carbonates. Chronic poisoning is so 
rare as to be disputed. The test for zinc in solution is the addition 
of ammonium sulphide, which precipitates white zinc sulphide, the 
only white sulphide met with. 

They are used as astringents in diarrhoeas ; as emetics ; as nerve 
tonics in epilepsy and chorea, and locally as astringents in conjunc- 
tivitis, gonorrhoea, etc. ; as sedatives and astringents in eczema and 
erysipelas; as dusting powders, and as mild stimulants to ulcers. 

Zinci Sulphas {zinc sulphate — white vitriol), dose as a tonic or 
astringent gr. ij-v (0.13-0.3); as an emetic (safer than copper sul- 
phate) gr. x-xx (0.6-1.3). Locally, as a collyrium or as an injec- 
tion in gonorrhoea, gr. j-ij (0.06-0.13) to fgj (30.0). 

Zinci Oxidum {zinc oxide) used internally in catarrhal diarrhoea, 
. membranous enteritis, epilepsy, chorea, and occasionally to check 
colliquative sweats. Dose gr. j-v (0.06-0.3) in pill. It is used also 
as a dusting powder. 

Oleeitum zinci {oleate of zinc) contains 5 per cent, of zinc oxide, 
and is used externally. 

The ointment {unguentum zinci oxidi) contains 20 per cent, of the 
salt and is much employed. 

Impure or commercial zinc oxide, sometimes called " tutty," is 
used in pharmacy. 

Zinci Acetas {zinc acetate) is used as a collyrium (gr. ij (0.13) to 
f^j (30.0)) as an injection in the third stage of gonorrhoea (gr. j-xx 
(0.06-1.3) to i%\ (30.0)) and in leucorrhoea (3j to Oj— about 4.0 to 
473.0). 

Zinci Carbonas Pr^ecipitatus {precipitated zinc carbonate) is 
used as a dusting powder and a mild astringent ointment (3j~^j 
—about 4.0 to 30.0). 

Zinci Chloridum {zinc chloride) is a powerful caustic and anti- 
septic, employed to destroy lupus and indolent granulations. It is 
used also to preserve cadavers for dissection. Burnett's disinfecting 
fluid contains gr. 200 to f&j (about 13.0 to 30.0). 



ASTRINGENTS — SILVER. 239 

Liquor zinci chloridi {solution of zinc chloride) may be used to 
disinfect water-closets and sinks. 

ZlNCl Iodidum (zinc iodide) is a local stimulant and caustic. 

Zinci Valerianas [zinc valerianate) is employed as a nerve tonic 
in epilepsy and chorea ; dose gr. j-ij (0.06-0.13) t. i. d. 

Zinci Bromidum (zinc bromide) is also official. 

Zinci Phosphidum (zinc phosphide) has been mentioned under 
phosphorus [vid. Mineral Tonics). 

ARGENTUM— SILVER. 

What are the physiological effects of silver? 

Metallic silver is inert. Of its soluble salts, the oxide and nitrate are 
chiefly employed. Locally applied the nitrate coagulates albumen, 
is an astringent and superficial caustic, contracting the cutaneous 
vessels and producing a white stain on the skin which becomes black 
on exposure to light. Taken internally they are astringent, and 
after absorption exert a tonic influence upon the nervous system. In 
targe doses they are gastro-intestinal irritants, often producing also 
violent convulsions, disturbed respiration, coma, dilated pupils, 
paralysis and death from respiratory failure. If too long continued, 
even in minute doses, chronic argyria results, consisting in emacia- 
tion, impaired memory and a peculiar indelible blue discoloration, 
first manifesting itself on the mucous membranes, and extending to 
the skin and internal organs. 

What are the tests for silver, and how should argyria be 
treated ? 

The addition of hydrochloric acid or sodium chloride to a solu- 
tion of silver produces a white precipitate of silver chloride, soluble 
in ammonia. Acute argyria is treated by giving immediately, as an 
antidote, a large amount of common salt, and treating symptoms 
p. r. n. In chronic argyria nothing does much good as a rule ; potas- 
sium iodide may be tried as an ehminative agent. 

What are the medicinal uses of the silver salts ? 

They are used as astringents in chronic diarrhoeas and in dysen- 
teries (internally or by enema) especially when ulceration is present, 
and are very useful in organic dyspepsias especially in gastric idccr 
and in chronic gastritis. As a nerve tonic they are employed in 



240 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. 

locomotor ataxia and other spinal scleroses. Externally as a stimu- 
lant and mild caustic the nitrate is applied to slowly granulating 
surfaces or to unhealthy ulcers. As an antiphlogistic and astringent 
it is used in solution in various inflammations of the mucous mem- 
branes, as conjunctivitis, pharyngitis, laryngitis, etc., and may be 
used as an injection in the later stages of gonorrhoea (gr. j-ij (0.06- 
0.13) to f^j (30.0)) in the male, or in acute vaginitis (painting the 
inflamed vagina with strong solutions). It is employed also in super- 
ficial inflammations of the skin, in erysipelas, and to prevent pitting 
in smallpox. 

What are the official silver salts and their doses ? 

Argenti Nitras {silver nitrate), dose gr. %-\ (0.008-0.016) 
gradually increased to gr. ss-j (0.032-0.06). Great care should 
be taken to prevent staining the skin. For external use solutions 
are employed varying in strength from gr. j-3ij (0.06-8.0) to fjj 
(30.0) of distilled water. 

Moulded silver nitrate or lunar caustic {argenti nitras fusus) is 
silver nitrate melted and poured into small moulds, for external use. 

Diluted silver nitrate {argenti nitras dilutus) is 30 parts of silver 
nitrate and potassium nitrate 60 parts, moulded as above. 

Argenti Oxidum (silver oxide), dose gr. ss-j (0.03-0.06) in pill. 

Argenti Iodidum (stiver iodide), dose as an alterative gr. j (0.06). 

Argenti Cyanidum (silver cyanide), used for preparing diluted 
hydrocyanic acid. 

BISMUTHUM — BISMUTH. 

What are the actions, uses and preparations of bismuth ? 

Metallic bismuth is inert. The less soluble salts are not actively 
toxic when pure, as they are absorbed with difficulty. Bismuth and 
ammonium citrate is much more irritant, and may in large doses 
cause gastro-enteritis. In medicinal doses, they are astringent and 
sedative to the mucous membranes. A portion is absorbed and is 
eliminated by the kidneys chiefly, while that which is not absorbed 
is converted into a sulphide and colors the stools black. Locally 
applied they are antiseptic and sedative. 

They are used internally as sedatives and astringents to check 



ANTACIDS. 241 

nausea and vomiting in gastric irritation, and to relieve pain in 
gastralgia, gastric ulcer and cancer. In acute diarrhoeas from 
irritation and in chronic diarrhoeas, especially those occurring in 
children during the summer months, they are very valuable. Ex- 
ternally as mild astringents and antiseptics they are useful in the 
treatment of ulcers, and as an injection (suspended in mucilage) in 
acute gonorrhoea and in vaginitis. They are also used as dusting 
powders in intertrigo and as snuff in acute coryza. 

Bismuth Subnitras {bismuth subnitrate) called also pearl white 
or magistery of bismuth, dose gr. v-3j (0.3-4.0). 

Bismuthi Subcarbonas {bismuth subcarboiiate) , dose gr. v-xxx 
(0.3-2.0). 

Bismuthi et Ammonii Citras {bismuth and ammonium citrate), 
dosegr. j-v (0.06-0.3). 

CERII OXALAS — CERIUM OXALATE. 

What is cerium oxalate ? 

It is supposed to resemble the salts of bismuth in its effects, but 
has not been investigated. It is used with success in reflex vomiting, 
particularly the vomiting of pregnancy. Dose gr. j-iij (0.06-0.19), 
t. i. d. in pill or capsule. 

ORDER V.— Antacids. 
What are antacids ? 

Antacids are remedies capable of neutralizing acids. The term, 
however, is here used in a more limited sense, and embraces only 
those medicines which are used in medicine to correct excessive 
acidity in the alimentary canal, as manifested by heartburn, 
acid eructations, gastric uneasiness, and diarrhoea of infants with 
1 ' chopped spinach stools. ' ' Excessive acidity may be due to an ex- 
cessive secretion of acid by the stomach, and here the antacids may 
be given after meals to neutralize the acid present, or the same effect 
may be produced by administering an acid before meals, which will 
decrease the acid secretion. On the other hand, it may be due to 
a deficient secretion of acid and consequent imperfect digestion and 
fermentation of the food. In these cases an antacid given before 
meals is useful by increasing the outward osmosis of acid, or a mix- 
ture of pepsin and acid after meals may supply the place of the 
deficient secretion. In acidity due to the development of the sarcina 
16 



242 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

ventriculi, sulphurous acid, the sulphites, carbolic acid or other 
antizymotics give the best results. 

Name the antacids employed for the above purposes. 

While all of the alkalies, alkaline earths and their carbonates are 
really antacids, yet in medical practice the sodium and calcium salts 
are chiefly used. Solution of potassa (q. v.) is sometimes, but not 
often, employed. The spirit and aromatic spirit of ammonia (q. v. ) 
are frequently used, especially in sick headache or where a stimu- 
lating antacid is required. 

SODIUM. 

What are the effects and uses of the sodium salts ? 

Caustic soda and its solution are escharotics. The sodium salts 
taken on an empty stomach increase the secretion of acid gastric 
juice, but if given after a meal in sufficient quantity they neutralize 
the acid present. They diffuse readily into the blood and act some- 
what as do the potassium salts, being, however, less irritant, more 
feebly diuretic, and possessing little if any poisonous influence ovei 
the (mammalian) heart, nerves or muscles. 

The medicinal uses of the sodium preparations have been con- 
sidered in discussing the general uses of the antacids. 

What are the preparations of sodium ? 

Liquor Sod^e (solution of soda), dose ttlij-x (0.12-0.3) freely 
diluted. 

Sodii Carbonas {sodium carbonate) is much used as an antacid 
in dyspepsia. In overdoses it is a corrosive poison. The antidotes 
are the vegetable acids. Dose gr. x-xxx (0.6-2.0). It is some- 
times deprived of its water of crystallization and prescribed in pill 
form as the dried carbonate (sodii carbonas eocsiccatus), in doses of 
gr. v-xv (0.3-1.0). 

Sodii Bicarbonas (sodium bicarbonate), is preferred to the 
carbonate because it is a more permanent salt and is less irritating 
to the stomach. Dose gr. x-xxx (0.6-2.0). It is an ingredient of 
seidlitz powders {q. v.) and other preparations. The troches 
(trochisci sodii bicarbonatis) each contain gr. iij (0.2) of the bicar- 
bonate. 

The other sodium salts are rarely used as antacids, and most of 
them have been sufficiently described previously. 



ANTACIDS — CALCIUM. 243 

CALCIUM. 

What are the effects, uses and preparations of calcium? 

Unslaked lime is a caustic. The calcium salts are antacid, 
slightly astringent and sedative to the mucous membranes, and are 
consequently much used in vomiting and in diarrhoea. The vapor 
arising from slaking lime is inhaled with advantage in membranous 
croup and in diphtheria. The preparations are Liquor Calcis 
(lime-solution — lime-water), used as an antacid and gastric sedative 
in nausea and vomiting from irritability of the stomach, and often 
added to milk to increase its digestibility and render it more readily 
tolerated by the stomach. As an antacid and astringent it is useful 
in diarrhoea, especially in teething children. Locally it is used as an 
alkaline wash in various skin affections and as a dressing to burns, 
scalds, ulcers, etc., in the form of the Liniment {linimentum calcis) 
often called carron oil (equal parts of lime-water and linseed 
oil). 

Syrupus Calcis [syrup of lime), a saturated, aqueous solution 
of calcium hydrate, the percentage of which varies with the temper- 
ature, but is about 0.17 at 59° F., is used as an astringent in diar- 
rhoeas and as an antidote to poisoning by carbolic acid. Dose f^ss- 
ij (2.0-8.0), freely diluted. 

Calcii Carbonas Pr^cipitatus {precipitated calcium carbon- 
ate) (dose gr. xx-.^j (1.3-4.0)) possesses no especial advantage over 
prepared chalk [cretce prceparata), which is used in diarrhoeas. 
Dose gr. x-xxx (0.6-2.0). They are used externally as dusting- 
powders in intertrigo. Compound chalk powder [pulvis cretce com- 
positus) contains 30 per cent, of prepared chalk. Chalk mixture 
{mistura cretce) contains 20 per cent, of the compound powder in 
water and cinnamon water, and is much used, combined with 
astringents and opium, in diarrhoeas, especially those of teething 
children. Dose f^ss-j (15.0-30.0). Troches of chalk (trochisci 
cretce) ; each contains gr. jv (0.25) of prepared chalk. 

Other preparations of calcium have been previously considered. 



244 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

GROUP II.— TOPICAL MEDICINES. 

Class I. — Antiseptics. 

What are antiseptics? 

Antiseptics are medicines which prevent fermentation and decom- 
position by destroying, or preventing the development of, the germs 
on which these processes depend. They are not always germicides 
(remedies which kill the germs of disease), for some of them hinder 
the growth and prevent the development of fresh germs, without 
destroying those already present ; nor are they always deodorants 
(remedies which destroy disagreeable odors), for the microbes of 
disease may be destroyed, and foul chemical emanations continue, or 
the latter may exist without the presence of the former. 

Name the chief antiseptics. 

Antiseptics may be divided, according to their chemical composi- 
tion, into the inorganic or elementary, and the organic antiseptics (or 
those belonging to the group of carbon compounds, including anti- 
septic oils and their camphors). To the first group belong hydro- 
gen dioxide, potassium permanganate, chlorine water, chlorinated 
lime, Labarraque's solution, mercuric chloride, bromine, iodine, 
mercuric iodide, iodoform, iodol, sulphurous acid, sulphites, sul- 
phides, boric acid, borates, and many of the mineral salts previously 
mentioned, as iron sulphate, lead nitrate, etc. In the second 
division are included carbolic acid and the carbonates, creosote, 
benzoic acid and the benzoates, naphthalin, naphtol, formaldehyd, 
the antipyretics {q. v.), the antiseptic oils [v. " Carminatives"), and 
thymol. 

AQUA HYDROGENII DIOXIDI— SOLUTION OF HYDROGEN DIOXIDE. 

What is solution of hydrogen dioxide ? 

It is a slightly acid, aqueous solution of hydrogen dioxide (also 
known as hydrogen peroxide), containing, when freshly prepared, 
about 3 per cent., by weight, of the pure dioxide, corresponding 



ANTISEPTICS— CHLORINE WATER. - 245 

to about 10 volumes of available oxygen. It occurs as a colorless 
liquid, without odor, but having a slightly acidulous taste. 

It parts readily with its oxygen, and thus acts as an oxidizing 
disinfectant. 

It is of course greatly inferior to mercuric chloride as a disinfect- 
ant, antiseptic, and germicide, but has the advantage of being non- 
poisonous. When brought in contact with pus, as on a suppurating 
surface, gas is evolved more or less abundantly, depending on the 
amount of pus present ; a slight, superficial coagulation forms on the 
surface and the pus corpuscles are disintegrated. 

It has been used as an antiseptic injection into abscess cavities after 
the evacuation of their contents, and into sinuses; and also as a local 
application to superficial wounds and idcers, whether of common or 
specific origin. It is also used as an injection in gonorrhoea. In 
scarlatinal or diphtheritic sore throat, and in tonsillitis, it is often 
used as a gargle or spray. 

It is a good buccal disinfectant and may advantageously be used 
for this purpose in typhoid and otJier low fevers, or in any case where 
the secretions tend to collect in the mouth and become offensive. 

On account of the oxygen evolved it is an active bleaching agent, 
and is used in solutions of 10 to 15 per cent, strength to bleach black 
hair. 

POTASSII PERMANGANAS — POTASSIUM PERMANGANATE. 

What is potassium permanganate? 

Potassium permanganate has been considered with the prepara- 
tions of manganese (v. " Mineral Tonics"). Its disinfectant powers 
are great, but it is decomposed immediately on contact with organic 
matter, and hence is chiefly used in solution as a gargle in scarlatina 
and diphtheria, as a lotion to cancerous and other ulcers, to correct 
foetor in otorrhoea, etc., and as an injection in leucorrhoea and in 
gonorrhoea. It is given internally as an emmenagogue (q. v. ). 

AQUA CHLORI — CHLORINE WATER. 

What is chlorine-water? 

It is an aqueous solution, containing at least 0.4 per cent, of 
chlorine. It is a powerful irritant and antiseptic. Albumin is the 
best antidote. 



246 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

It is chiefly used, diluted, as a gargle in diphtheria, and as a wash 
for foul ulcers and wounds. 

CALX CHLORATA — CHLORINATED LIME. 

What is chlorinated lime ? 

It is composed of calcium hypochlorite and chloride, and when 
exposed to the air is decomposed, yielding about 35 per cent, of 
chlorine. It is an antiseptic, and is used to disinfect the air of sick 
rooms, urine, sputum and fecal discharges and privies. 

LIQUOR SOD.E CHLORATE — SOLUTION OF CHLORINATED SODA. 

What is this substance ? 

Solution of chlorinated soda, or Labarraquds solution, contains 
at least 2.6 per cent., by weight, of available chlorine, and may be 
used for the same purposes as the foregoing preparations. 

HYDRARGYRI CHLORIDUM CORROSIVUM — MERCURIC CHLORIDE. 

What is mercuric chloride? 

This preparation has been considered with the mercurial salts (v. 
"Alteratives"). It is a valuable germicide, and is used in aqueous 
solutions of various strengths (1-2000 to 1-16,000) in all manner of 
surgical operations and affections where an antiseptic is required and 
can be employed. As several cases of poisoning have been reported, 
especially from its use in gynaecological and obstetrical practice, it 
should be employed with some caution. 

BROMUM — BROMINE. IODUM — IODINE. 

Are these substances antiseptic? 

Bromine (v. " Eschar otics") and iodine are powerful antiseptics, 
but are rarely used for this purpose, as their management requires 
great care and experience. 

HYDRARGYRI IODIDUM RUBRUM— MERCURIC IODIDE. 

Is mercuric iodide antiseptic? 

Mercuric iodide is a powerful germicide, and has been employed 
as a substitute for corrosive sublimate, but, so far, has not super- 
seded the latter. 



ANTISEPTICS— IODOFORM. 247 

IODOFORMUM — IODOFORM. 

What is iodoform? 

Iodoform is formyl teriodide, and occurs in minute yellowish crys- 
tals, with a disagreeable odor. It is insoluble in water, but freely 
soluble in ether and alcohol. 

What are its effects and uses? 

Locally, it is an antiseptic and local anaesthetic. It prevents the 
multiplication of germs, but will not destroy them if present before 
its use. It seems to be more readily absorbed by abraded than by 
mucous surfaces. Internally, it is tonic and alterative. Moderate 
doses stimulate the cardio-inhibitory centre, slowing and strengthen- 
ing the cardiac beat and elevating the blood pressure, while large 
doses depress this centre, and finally paralyze the cardiac muscle. 
The temperature is generally reduced. It increases the salivary, 
biliary and intestinal secretions, and is eliminated chiefly by the 
kidneys (as sodium iodate), but to a slight extent by the lungs also. 
When excessive amounts are absorbed, either from internal or 
external sources, glomerulo-nephritis and fatty degenerations of 
various organs occur. Cases of poisoning may be divided into six 
classes, the danger increasing progressively from the first to the last : 
1. High fever ; 2. Fever, gastro-entero irritation, rapid pulse ; 3. 
Very rapid, compressible pulse, no fever ; 4. Very rapid pulse and 
high fever ; 5. Great depression and collapse, rapidly fatal ; 6. 
Symptoms like meningitis. Should poisoning occur, remove every 
particle of the dressing if it has been used locally, give opium and 
stimulants and treat symptoms. Iodoform has been used internally 
as a cardiac tonic in valvular disease with insufficient hypertrophy, 
and as an alterative in syphilitic rheumatism, neuralgiae and the early 
stages of phthisis. In diabetes mellitus it has been advantageously 
given. Externally, it is employed as an anaesthetic and antiseptic 
drying to irritable ulcers of all kinds, burns and wounds. In 
ethereal solution it has been injected into the cavities of strumous 
abscesses, after the evacuation of their contents, to destroy the 
giant cells of tubercle and promote healthy granulation. In sup- 
positories it is u*ed in inflammation and ulceration of the vagina, 
uterus and rectum. Bougies containing iodoform are sometimes 
used in septic affections of the uterus and in gonorrhoea. 

Dose gr. \-y (0.01-0.3), in pill or capsule. 



248 ESSENTIALS uP MATERIA MEDICA AND THERAPEUTICS. 

The ointment (unguentum iodoformi) contains 10 per cent, of 
iodoform. 

IODOL. 

What is iodol? 

Iodol (not (official) is made by the action of iodine on pyrol, and 
contains 88. 9 per cent, of the former. It is recommended as a sub- 
stitute for iodoform, being tasteless, odorless, and, as it is more 
slowly absorbed, less likely to produce dangerous effects. It is espe- 
cially recommended in nasal, pharyngeal and laryngeal cases, par- 
ticularly in tubercular laryngitis, and may be used either in powder 
(by insufflation) or in solution with alcohol and glycerin. It has 
also been used internally in those cases to which iodoform is appli- 
cable. Dose gr. ss-iij (0.03-0.19), in pill or capsule. 

ACIDUM SULPHUROSUM — SULPHUROUS ACID. 

What is sulphurous acid ? 

Sulphurous acid is an aqueous solution of about 6.4 per cent., 
by weight, of sulphurous acid gas. 

What are its effects and uses ? 

It is a powerful deoxydizing agent, and deodorant. When suffi- 
ciently concentrated the gas is probably a germicide. When inhaled 
it is irritant, and, if in sufficient amount, causes inflammation and 
even acts as a caustic from the formation of sulphuric acid. It is 
eliminated by the urine and feces as sulphates. It is used internally 
(diluted) in yeast-vomiting to prevent the formation of sarcina ven- 
triculi in flatulency depending on fermentation of the food, and 
locally as a wash in various parasitic skin diseases. In the form of 
burning sulphur it is employed to disinfect rooms. Dose Triv-f3j 
(0.3-4.0), freely diluted. 

THE SULPHITES AND SULPHIDES.* 

What are the effects and uses of these salts ? 

The effects of the sulphites depend upon the sulphurous acid which 
they contain, and which is readily evolved on the addition of almost 

*See footnote, p. 71. 



ANTISEPTICS— BORIC ACID. 249 

any acid. On exposure to the air they are converted into sulphates. 
Taken internally they are decomposed by the acid of the gastric 
juice, evolve sulphurous acid, are finally converted into sulphates, 
and thus absorbed and eliminated. They are used to fulfill the indi- 
cations for sulphurous acid. The dose of sodium sulphite {sodii 
sulphis) is gr. v-xxx (0.3-2.0) t. i. d. ; sodium bisulphite (sodii bisul- 
phis) gr. v-xx (0.3-1.3); sodium hyposulphite [sodii hyposulphis) 
gr. v-xx (0.3-1.3). 

The sidphides are said to possess the power of arresting the forma- 
tion of pus in threatened boils and abscesses, and are used internally 
for this purpose. 

Calx sulphurata [sulphurated lime) consists of a mixture contain- 
ing at least 60 per cent, of calcium monosulphide together with 
unchanged calcium sulphate and carbon, in varying proportions, and 
is given in doses of T V~i (0.006-0.03), repeated every h-l hour. 
Sulphurated potassa will be found among the sulphur preparations 
[v. " Cathartics"). 

ACIDUM BORICUM — BORIC ACID. 
SODII BORAS — BORAX. 

What are the effects and uses of boric acid and its salts ? 

Locally boric acid is antiseptic and deodorant. Internally they 
are somewhat diuretic, and retard the decomposition of the urine. 
Two fatal cases from the injection of large quantities into the pleural 
sac, and the cavity of a large lumbar abscess, have been reported, 
death being due to collapse and cardiac failure. 

Boric acid is used as an antiseptic in powder or solution in many 
external inflammations and wounds, and in inflammations and aph- 
thous or diphtheritic ulcerations of the mouth and fauces, the acid 
or its salts are of undoubted value. 

In solution it has also been used to wash out abscess cavities and 
as an injection in gonorrhoea. As a disinfectant and deodorant in 
ophthalmic and aural practice it is very useful. Boric acid is recom- 
mended internally in cystitis depending on ammoniacal decomposition 
of the urine, and as an injection into the bladder in the cystitis of 
spinal diseases. Dose of the acid gr. v-x (0.3-0.6), t, i. d. ; of the 
saltgr. xx-3j (1.2-4.0). 



250 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Glyceritum boroglycerini {glycerite of boroglycerin — glycerite of 
glyceryl borate — solution of boroglycerite) is made by dissolving 31 
per cent, of boric acid in glycerin by means of heat, and is used as 
an external application for the disinfection of unhealthy ulcers or 
suppurating surfaces generally. 

It is a useful application to burns, and has been applied with 
advantage to inflamed mucous membranes, as the pharynx, nasal 
passages, or conjunctiva. 

ACIDUM CARBOLICUM— CARBOLIC ACID. 

What is carbolic acid ? 

Carbolic acid, phenol or pJienic acid is an oily liquid, or crystalline 
solid, which readily deliquesces, and is derived from coal-tar by 
fractional distillation. 

What are the tests for carbolic acid? 

The addition of ferric sulphate produces a lilac color ; bromine- 
water causes a yellowish precipitate ; it coagulates albumen, and 
precipitates nitro-cellulose from collodion. 

What are its physiological actions? 

Carbolic acid is a local anaesthetic and caustic (producing a white 
eschar) when used in concentrated solutions ; it is antiseptic and 
germicide. Internally, it is a powerful gastro-intestinal irritant 
when taken undiluted. In diluted solutions it is an astringent. 

It first stimulates and then exhausts the vagi (causing slowing, 
followed by acceleration of the heart's action, which is finally para- 
lyzed), reduces the arterial pressure by paralyzing the vasomotor 
centres of the cord, increases and then depresses the respiratory 
movements, from its influence on the vagi and respiratory centre, 
and in large doses lowers the temperature slightly. In poisonous 
doses it causes vertigo, tremors, contracted pupils, stupor, coma, 
impaired motion, sensation and reflex action, and in the lower ani- 
mals convulsions of spinal origin. It is eliminated chiefly by the 
kidneys and lungs, imparting a smoky color to the urine when the 
dose is excessive. 

This is a sign of impending danger. 

If poisoning occur from external applications, remove the dress- 
ings immediately ; if the acid has been swallowed, give a saturated 



ANTISEPTICS — THE SULPHOCARBOLATES. 251 

solution of calcium carbonate. In either case administer atropine 
hypodermically, to counteract its respiratory and cardiac effects, and 
diluents freely, to aid its elimination. 

What are its medicinal uses ? 

Carbolic acid was used externally as an antiseptic dressing and 
lotion in the various surgical affections and operations to which the 
mercuric chloride is applicable. It has also been used as a local 
anaesthetic previous to minor surgical operations, as the opening of 
small abscesses and felons, and in dilute solution to allay pruritus. 
It has been injected into the cavities of chronic abscesses and of the 
tunica vaginalis, to cause obliteration of their sacs after the with- 
drawal of the contained fluid. 

Internally carbolic acid has been much used as a gastric sedative 
to check vomiting ; as an astringent in diarrhoea ; as an antifermen- 
tative; as a germicide in sarcina ventriculi ; and as an antizymotic 
in typhoid fever, smallpox, scarlatina, and diphtheria. It is also 
used by inhalation in nasal catarrh, hay fever, bronchorrhoea, per- 
tussis, and pulmonary gangrene. 

What are its preparations and doses ? 

Acidum Carbolicum {carbolic acid), dose gr. j-ij (0.06-0.13). 

Glyceritum Acidi Carbolici (glycerite of carbolic acid) contains 
20 per cent, of the acid dissolved in glycerin. Dose tt\, ij-v (0.12- 
0.3). 

Acidum Carbolicum Crudum (crude carbolic acid) may be used 
externally as a disinfectant. The ointment {unguentum acidi car- 
bolici) contains 5 per cent, of the acid. 



THE SULPHOCARBOLATES. 

What are the sulphocarbolates ? 

Sodii sulphocarbolas {sodium sulphocarbolate or sodium para- 
phenol sulphonate) — the only one which is official - is used inter- 
nally to fulfill the indications of carbolic acid, and as an antifermen- 
tative in flatulency from fermentation of the food. It is also used 
locally as a sedative application to inflamed mucous membranes. 
Dose gr. x-xv (0.6-1.0) t. i. d. 



252 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
CREOSOTUM— CREOSOTE. 

What is creosote? 

Creosote is a substance closely resembling carbolic acid, derived 
from wood-tar by dry distillation. It may be distinguished from 
carbolic acid by not coagulating collodion. It resembles carbolic 
acid in its effects and uses, and a solution of the latter is generally 
sold for it in the shops. The dose of pure creosote is ^lj-iij (0.06- 
0.18). 

Aqua creosoti {creosote water) is a 1 per cent, solution of creosote. 



ACIDUM BENZOICUM — BENZOIC ACID. 

What is benzoic acid ? 

Benzoic acid is obtained from benzoin by sublimation, and is an 
ingredient of many of the substances (the balsams) previously con- 
sidered. Locally it is an irritant, antiseptic aud germicide. Inter- 
nally it increases the secretions generally, and is eliminated chiefly by 
the urine increasing the acidity of that fluid, hence its value in the 
phosphatic diathesis. It has been used locally as an antiseptic in 
the treatment of wounds and ulcers, but is not much employed for 
these purposes at present. It is also used as a stimulant and anti- 
septic application in the treatment of chapped hands, fissured nip- 
ples, etc., but for this purpose the preparations of benzoin are 
preferred. Benzoic acid or its salts are of great value in the treat- 
ment of cystitis from alkaline urine, phosphatic deposits in the urine, 
etc. , for by acidulating the urine it renders the phosphates more 
soluble. They are also used internally as antiseptics in diphtheria, 
erysipelas, etc. Benzoic acid is added to unguents, to prevent ran- 
cidity. The dose is gr. v-xx (0.3-1.2) ; but for internal administra- 
tion the salts are generally preferred. 

Sodii benzoas [sodium benzoate) has been used as an antipyretic 
in rheumatism, and as an antiseptic in pertussis, diphtheria, and the 
exanthemata. Dose 3j-ij (4.0-8.0). 

Ammonii benzoas {ammonium benzoate) is the best remedy for 
incontinence due to vesical irritation from alkaline decomposition of 
the urine. Dose gr. v-xx (0.3-1.2). 



ANTISEPTICS— NAPHTOL. 253 



NAPHTALINUM— NAPHTALIN. 



What is naphtalin ? 

Naphtalin, also called naphthalene ox naphthalin, is a hydrocarbon 
obtained from coal-tar, occurring in colorless, transparent plates, and 
having a strong, peculiar odor, and a burning, somewhat aromatic 
taste. It is soluble in alcohol, but insoluble in water. 

Naphtalin is antiseptic and antiparasitic. Locally it is mildly 
stimulant. When given internally in large doses or for a length of 
time it causes gastric irritation. Very little is absorbed when taken 
internally, the greater part being eliminated by the faeces and act- 
ing as an intestinal antiseptic. Some little, however, passes into the 
system and is eliminated by the kidneys and by the lungs. It is said 
that its continued administration to animals has resulted in cataract. 

It is chiefly used as an intestinal antiseptic in typhoid fever, diar- 
rhoeas, and dysentery. It is also used as an anthelmintic, given inter- 
nally for the removal of lumbrici, or used as an injection (gr. x-xx 
(0.6-4.2)) in sweet oil (f$iij (90.0)) to destroy the oxyuris. It has 
also been given in pyelitis, cystitis, etc. , for its antiseptic effect on 
the urine, and has been employed in the treatment of bronchorrhoea 
and fcetid bronchitis. As a local antiseptic it is not much used. It 
has been used as a dressing for wounds, ulcers, and chronic abscesses. 
Dose gr. ij-x (0.12-0.64), administered in capsules. 

NAPHTOL. 

What is naphtol ? 

Kaphtol, also called isonaphthol or bctanaphthol, is a hydrocarbon 
prepared from naphthalene. It occurs as a white or yellowish-white 
powder, or in crystalline plates, with a faint phenol-like odor and a pun- 
gent taste. It is freely soluble in alcohol, but only slightly so in water. 

In its action it resembles closely naphthalene. In animals large 
doses cause death by respiratory paralysis. No toxic symptoms have 
been reported in the human subject from its use. 

Its uses are similar to those of naphtalin. It is a good intestinal 
antiseptic, preventing fermentation and consequent flatulence, and 
is used in gastric or intestinal fermentation, in dilated stomach, and 
in diarrhoeas and dysentery. Dose gr. ij-v (0. 12-0.32) although 
much larger doses have been given without deleterious effect. It is 
usually administered in capsules, which may be keratin-coated when 



254 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

used as an intestinal antiseptic. It is often advantageously com- 
bined with bismuth subnitrate and sodium bicarbonate. 

FORMALDEHYD. 

What is this substance? 

Formaldehyde or formic aldehyd (not official), is an aqueous solu- 
tion containing 40 per cent, of formalin or formal, obtained by 
oxidation of methyl alcohol. It forms a colorless solution having a 
pungent odor and taste. It has been much used as a deodorant and 
disinfectant and is said to be poisonous in a very moderate degree. 
Concentrated solutions applied to the skin arc said (R. H. Cun- 
ningham) to cause a peculiar necrosis, unaccompanied by signs of 
inflammation. The gas is liberated by heating the solution, and it 
is said that an atmosphere containing 2.5 per cent, of the gas is 
speedily fatal to all micro-organisms. 

It has been used to disinfect the surgeon's hands and instruments, 
in the preparation of aseptic catgut ligatures, and in dilute solu- 
tions (1 : 2000) in the treatment of gonorrhoea!, affections of the 
female. In the male it has sometimes effected a cure in acute 
gonorrhoea, more frequently when the disease was situated in the 
deeper parts of the urethra, Occasionally the irritation caused by 
its use was so great that the irrigation had to be discontinued. It 
has also been used in solutions of the same strength in acute con- 
junctivitis. Recently it has been recommended as a spray (1 per 
cent, solution, in the treatment of pertussis, and, used in the same 
manner, is strongly recommended in the treatment of hay asthma. 

The Antipyretics and Antiseptic Oils. 

Are these substances used as antiseptics ? 

The antipyretics {q. v.) have been sufficiently considered. 

The antiseptic properties of the volatile oils classed with the 
''Carminatives" (q. v.) have been alluded to under that head. 
Those of importance not hitherto mentioned are : 

THYMOL. 

What is thymol? 

Thymol {cymylic phenol) is a crystalline substance found in the oil 
of thyme (oleum thymi) (q. v. ) . Locally it is a powerful antiseptic and 



ANTISEPTICS— THYMOL. 255 

local anaesthetic. Given internally it lowers febrile temperature to 
some extent, and causes diaphoresis. In excessive amount it causes 
tinnitus aurium, deafness, diarrhoea, and sometimes delirium and col- 
lapse. It is used as an antiseptic gargle and mouth-wash in aph- 
thous and diphtheritic ulcers of the mouth and fauces, and internally 
as a gastric sedative to allay vomiting. As an anti-fermentative, in 
flatulency from fermentation of the food and in intestinal indigestion, 
\i is very useful. Dose gr. ss-ij (0.03-0.13). As much as gr. xx- 
xxx (1.2-2.0) have been given in 24 hours. It is administered in 
solution in glycerin, alcohol, and water. 



256 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 



Class II. — Irritants. 

What are irritants ? 

Irritants are medicines which are used locally to produce counter- 
irritation or inflammation of the parts to which they are applied. 
They are divided, according to the violence of their action, into Rube- 
facients, Vesicants, Suppurants, and Escharotics or Caustics. 



ORDER I.— Rubefacients. 
What are rubefacients ? 

Rubefacients are medicines which are employed to produce a pow- 
erful but temporary irritation and congestion of the surface. They 
are useful in arousing the system in shock ; in stimulating the circu- 
lation of a part in case of frost-bite, or to aid in bringing on reaction 
in the cold stage of a congestive chill ; in all cases of congestion and 
in the formative stages of inflammations. The application of rube- 
facients for the relief of neuralgic and muscular pains is often fol- 
lowed by improvement which may even be permanent. 

Mention the principal rubefacients. 

Mustard ; capsicum ; oil of turpentine ; ammonia ; Burgundy 
pitch, and Canada pitch. 

SINAPIS ALBA — WHITE MUSTARD. 
SIN APIS NIGRA — BLACK MUSTARD. 

What is mustard ? 

Mustard is the seed of Brassica alba, or white mustard, and B. 
nigra, or black mustard {Nat. Orel. Cruciferas). 

What chemical principles do they contain? 

Mustard seed contains a fixed oil. Black mustard seed yield on 
distillation a volatile oil (allyl sulphocyanide) which does not preexist 
in the seed, but is formed by the action of water on sinigrin or potas- 
sium myronate. The white seed yield an acrid fixed principle which 
is formed by the action of water on sinalbin. These changes are 
probably due to the presence of myrosin, an albuminous ferment. 



IRRITANTS — BURGUNDY PITCH. 257 

What are the effects and uses of mustard ? 

Locally, it is an irritant rapidly causing redness and a sensation of 
heat ; if the application is long continued, inflammation and even gan- 
grene may result. Internally it is a stomachic in small doses, an 
emetic in larger amounts, and a severe gastro-intestmal irritant if an 
excessive quantity be taken. 

Mustard is used as a rubefacient in the form of a mustard plaster 
(made of the powdered seed known as mustard flour), whenever a 
mild counter-irritant effect is desired. The mustard should not be 
allowed to come in contact with the skin, but should be separated 
from it by a piece of gauze or a fold of muslin or newspaper. When 
a prolonged but gentle effect is desirable, the mustard may be added 
to a flaxseed poultice or diluted with flour. Internally, mustard- 
flour is used as an emetic, and is especially valuable when torpor of 
the stomach is present. 

What are the preparations of mustard, and their doses ? 

The dose of powdered mustard as an emetic is 3j-iv (4.0-16.0). 

The official preparations are mustard-papers (charta sinapns), a 
convenient form for external use. Each square inch of paper con- 
tains about gr. vj of black mustard deprived of its oil. They should 
be dipped in warm water before applying. The volatile oil (oleum 
sinapis volatile) is very irritant, and is used in preparing the cam- 
pound liniment (linimentum sinapis composition). 

CAPSICUM. OIL OF TURPENTINE. AMMONIA. 

Are these substances used as rubefacients ? 

The uses of these substances as rubefacients will be found in 
detail under the respective drugs. 

Linimentum ammonia' {liniment of ammonia) contains 3.5 per 
cent, of ammonia water in cotton-seed oil and alcohol. 

PIX BURGUNDICA— BURGUNDY PITCH. 

What is Burgundy pitch? 

Burgundy pitch is the prepared resinous exudation from Abies 
excelsa, or Norway spruce [Nat. Ord. Conifers). It contains a 
resin and a volatile oil, and is a mild rubefacient, used in the form 
of plaster in subacute and chronic bronchitis, to the back in lumbago, 
and to the joints in chronic rheumatism, 
17 



258 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Pitch plaster with cantharides [emplastrum picis cum cantharide) 
is more stimulating than the plaster {emplastrum picis Burgundicce). 
Iron and opium plasters contain Burgundy pitch. 



ORDER II.— Vesicants. 
What are vesicants? 

Vesicants are remedies which, when applied to the skin, cause 
sufficient inflammation to produce an effusion of serum under the 
cuticle, or, in other words, to raise a blister. They are also called 
epispastics, or blisters. They are used in inflammations of the serous 
membranes, especially when accompanied by an outpouring of serum ; 
to deplete the vessels in inflammations of the brain and its mem- 
branes ; in chronic joint affections ; in neuritis, and for the relief of 
various neuralgic pains, and are sometimes used in inflammations 
of the parenchymatous viscera. They are contraindicated in the 
very young or very old, where there is great depression of the vital 
powers, or where there is very high arterial tension. 

Name the principal vesicants. 
Spanish fly, potato fly, and stronger water of ammonia. 

cantharis — cantharides. 

What is cantharides ? 

Cantharis vesicatoria or Spanish fly ( Class, Insecta; Order, Coleop- 
tera) is an insect found in the temperate parts of Europe, but especi- 
ally in Spain and Italy. When dried they contain a volatile oil and 
a neutral crystalline principle, cantharidin, the vesicating principle. 

What are its effects and uses ? 

Locally, cantharides is an intense irritant to any surface with which 
it comes in contact ; thus, applied to the skin it causes inflammation 
of sufficient intensity to result in a serous effusion under the cuticle, 
and if the application be too long continued, gangrene may result. 
Constitutional effect may be caused from the local application of 
cantharides. Internally, in small doses, it is diuretic ; in larger 
amounts it is an irritant, causing pain on urination, priapism, 
strangury, and even bloody urine. Sexual desire does not usually 
occur. In excessive doses it is a gastro -enteric irritant, -causing 



SUPPURANTS. 259 

vomiting and purging, and even death, often preceded by dilated 
pupils, delirium, convulsions, and collapse. On post-mortem ex- 
amination severe inflammation of the alimentary canal, kidneys, and 
bladder is found. The treatment consists in removing the applica- 
tion, or evacuating the contents of the stomach ; the free use of 
diluents ; opium (especially by the rectum) ; and avoiding all oily 
substances, as these aid the absorption of the poison. 

What are its medicinal uses ? 

The internal uses of cantharides have previously been noticed 
{v. " Emmenagogues" and "Diuretics"). Externally it is used as 
a blistering agent, almost to the exclusion of other remedies. It 
must be remembered that poisoning may result from its local appli- 
cation. 

What are its preparations and their doses ? 

The cerate, (ceratum cantharidis) is used locally as a blistering 
agent, and is often known as blistering cerate. Cantharidal collo- 
dion (collodium cant ha ri datum) is applied with a brush, and is 
a convenient way of applying a blister to an irregular surface. The 
tincture (tinctura cantharidis) is used internally; dose gtt. v-x 
(0.3-0.6). 

CANTHARIS VITTATA— POTATO FLY. 

What is this substance ? 

The potato fly (not official) is an indigenous insect which contains 
cantharidin, and may be used as a substitute for the Spanish fly. 

AQUA AMMONUE FORTIOR — STRONGER WATER OF A3IMONIA. 

Is this ever used as a blistering agent? 

Stronger ammonia-water is a rapid but painful vesicant. 

It forms the basis of Granville 's vesicating lotion and of Gondret \s 
vesicating ointment, It is but little used for this purpose. 



ORDER III.— SUPPURANTS. 

What are suppnrants? 

Suppurants are remedies which cause such powerful irritation of 
the surface to which they are applied as to produce a crop of pus- 



260 ESSENTIALS OP MATERIA MEDICA AND THERAPEUTICS. 

tules. They are seldom employed at present except as an appli- 
cation to the throat and chest in chronic laryngeal or bronchial 
affections, or to the surface of a joint when chronic inflammation is 
present. The only medicines belonging to this order are Croton oil 
and antimonial ointment. These remedies have been previously 
described. Antimonial ointment is the more painful and its effects 
are more lasting. It is no longer official. 



ORDER IV.— Escharotics. 

What are escharotics? 

Escharotics are medicines which are applied locally to destroy the 
structure and vitality of the tissues. The dead tissue excites inflam- 
mation, and is thrown off by ulcerative action. It is called the 
slough, or eschar. Escharotics are used to destroy morbid growths, 
as lupus, epithelium, condylomata, warts, fungous granulations, etc. ; 
to destroy the virus of malignant pustule, hospital gangrene, the 
bites of rabid animals or poisonous reptiles, the virus of chancre, 
etc. ; to substitute a healthy for diseased action, and to stimulate 
indolent ulcers, sinuses, etc. 

Mention the principal medicines used for these purposes ? 

Caustic potash ; caustic soda ; arsenious acid ; bromine ; zinc 
chloride ; acid nitrate of mercury ; corrosive sublimate ; potassium 
bichromate ; the mineral acids ; silver nitrate ; copper sulphate ; and 
burnt alum. 

POTASSA. 

What is potassa ? 

Potassa is formed by the rapid evaporation of the solution of po- 
tassa, and is moulded into thin cylindrical sticks. 

What are its effects and uses ? 

It is an exceedingly powerful caustic, destroying the surrounding 
tissues and penetrating to some depth below the surface. When it 
is used, it is well to protect the surrounding tissues from its action 
by adhesive plaster with a hole cut in its centre, through which the 
caustic is applied. It is used when a powerful effect is desired. 

Potassa cum Calce {potassa with lime) consists of equal parts of 
potassa and quicklime, and is a powerful caustic. It is sometimes 
called Vienna paste. 



ESCHAROTICS— ZINC CHLORIDE. 261 

SODA. 

What is soda ? 

Caustic soda is made by the rapid evaporation of the solution of 
soda, and is a very powerful caustic, resembling potassa in its effects 
and uses. London paste is made by rubbing up equal parts of soda 
and lime. 

ACIDUM ARSENOSUM — ARSENOUS ACID. 

Is arsenous acid used as a caustic ? 

The uses of this substance as a caustic will be found under the arti- 
cle "Arsenic" (v. "Alteratives"). 

BROMUM — BROMINE. 

What is bromine ? 

Bromine is a halogen element, and is a very powerful caustic. It 
is a volatile liquid, and has very great affinity for hydrogen. Locally 
it is a powerful deodorant and disinfectant, and a severe and deeply 
penetrating caustic. When inhaled, it is an intense irritant, pro- 
ducing laryngitis, bronchitis and even pneumonia. Internally, if not 
sufficiently diluted, it is a corrosive poison. It is used as a caustic 
in hospital gangrene after the removal of the slough. As it is heavier 
than water it may be poured into a wide-mouthed bottle half filled 
with water, which will prevent it from giving off irritating fumes. 
From this it may be sucked up with a syringe and injected into the 
wound which it is desired to cauterize. The fumes are sometimes 
cautiously inhaled for the cure of acute coryza, chronic nasal catarrh, 
ozcena. hay asthma, etc. For purposes of inhalation a solution of 
3ss (2.0) in jfjv (120.0) of alcohol may be used. 

ZINCI CHLORIDUM — ZINC CHLORIDE. 

LIQUOR HYDRARGYRI NITRATIS— SOLUTION OF MERCURIC NITRATE. 

HYDRARGYRI CHLORIDUM CORROSIVUM — MERCURIC CHLORIDE. 

Are these medicines escharotics ? 

The uses of these substances as caustics will be found under Zinc 
{v. ""Astringents ") and Mercury (v. "Alteratives"). 



262 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 
POTASSII BICHROMAS — POTASSIUM BICHROMATE. 

What is potassium bichromate ? 

It is an irritant internally, and in overdoses a corrosive poison. 
Externally it is a caustic, used to destroy syphilitic condylomata, 
warts, etc. Internally it is used as an alterative in doses of gr. \ 
(0.013) t. i. d. 



The Mineral Acids. 
Are the mineral acids used as caustics ? 

The mineral acids are powerful caustics, and are often employed 
to remove warts, or other excrescences, to cauterize chancres, indo- 
lent sinuses and ulcers. Nitric acid is preferred as an escharotic. 

Silver Nitrate, Copper Sulphate, and Alum have all been 
previously spoken of as caustics under their appropriate heads. 



DEMULCENTS. 263 



Class III. — Demulcents. 

What are demulcents ? 

Demulcents are bland remedies which, when applied to inflamed 
or irritated surfaces, exert a soothing influence upon them and are 
employed internally for this purpose. They are used in acute inflam- 
mations of the alimentary canal ; in pharyngeal, laryngeal and 
bronchial irritation ; in renal, cystic, and urinary affections gener- 
ally ; and to suspend medicinal substances which are insoluble in 
water. They are also used as light articles of diet. 

Describe the demulcents. 

Aqua [icater) is used in medicine in its purest attainable state, 
i. e. , rain or melted snow. For pharmaceutical purposes it should 
only be used in the form of distilled water {aqua destiUata), A 
certain amount of water is necessary for the proper performance of 
the functions of the body. It is an active diuretic, increasing not 
only the watery, but also the solid ingredients of the urine. It is 
eliminated by the kidneys, skin, lungs and bowels. It is used as a 
diuretic in acute renal diseases, and is also often serviceable in 
chronic Bright' s disease. To dilute a highly concentrated urine in 
ardor urince, especially when there is a tendency to the formation 
of gravel or calculi, it is invaluable. 

It is useful in fevers, as it aids the elimination of the waste pro- 
ducts. ExternaEy, it is used in the form of baths, either hot v?r 
cold, not only for purposes of cleanliness, but also as a therapeutic 
agent. Impregnated with carbonic acid gas under pressure, it 
makes an agreeable drink known as soda-water, which is often useful 
in allaying nausea and vomiting. 

Acacia, or gum arabic, is a gummy exudation from Acacia Sen- 
egal (Nat. Ord. Leguminosre), a tree of Africa. It contains arable 
acid, and is much used in solution as a demulcent in various forms 
of sore throat. It is also used in making emulsions and pills. 

Its preparations are: a, mucilage {mucdago acacice) and & syrup 
(syrupus acacice). Emulsion of almonds (emulsum amygdala-) is 
an agreeable form for administration. 



264 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 

Tragacantha (tragacanth) is a gwrnmy exudation from Astra- 
galus gummifer and other species of Astragalus {Nat. Ord. Legu- 
minosse}j and contains arabin and tragacanthin. It is only used 
internally as an agent to suspend heavy powders or to give consist- 
ence to lozenges. A mucilage (mucilago tragacanthce) is official. 

Ulmus (elm) is the inner bark of the Ulmus fulva, or slippery 
elm (Nat. Ord, Urticaceae), and contains a large amount of muci- 
laginous matter, and though more often used externally as an emol- 
lient poultice, is sometimes employed as a demulcent in inflamma- 
tions of the bowels, and in laryngitis. A mucilage (mucilago ulmi) 
is official. 

Althaea, the root of A. officinalis, or marsh- mallow (Nat. Ord. 
Malvaceae), is a pleasant demulcent. A syrup (syrupus althaxe) is 
official. 

Linum (flaxseed) is the seed of Linum usitatissimum, or flax ( Nat. 
Ord. Lineae), and contains flxcd oil, mucilaginous matters, vegetable 
albumen, etc. The oil (oleum lini) is a laxative, but is chiefly used 
externally in emollient liniments. The seed may be used internally 
as an infusion, flavored with lemon and sugar (flaxseed tea), in 
bronchial catarrhs, enteric inflammations, dysentery, and renal, ves- 
ical, or urethral irritations. The ground seed are much used to 
make emollient poultices. 

Sassafras Medulla {sassafras pith) is the pith of the stems of 
S. variifolium {Nat. Ord, Laurineas). The mucilage (mucilago sas- 
safras medulla) may be used internally as a demulcent, but is chiefly 
employed locally in inflammations of the eye. 

Glycyrrhiza, commonly called liquorice-root, is the root of Gr. 
glabra (Nat. Ord. Leguminosae). It contains a glucoside (glyeyrrhi- 
zin), asparagin, resin, etc. It is chiefly used as a demulcent in 
catarrhal affections of the respiratory organs and to disguise the 
taste of quinine, of the ammonium salts, and of other disagreeable 
medicines ; occasionally, also, in kidney and bowel complaints. The 
preparations are an extract (extractum glycyrrliizai), often called 
liquorice ; refined extract (extractum glycyrrliizce purum) ; fluid ex- 
tract (extractum glycyrrliizaz fluidum), used as an addendum to 



DEMULCENTS. 265 

cough medicines ; ammonia ted glycyrrhizin (glycyrrhizinum ammo- 
niatum) dose gr. v-x (0.3-0.6); compound glycyrrhiza mixture, 
brown mixture {mistura glycyrrhizoi composita) contains the refined 
extract, mucilage of acacia, syrup, paregoric (12 per cent.), anti- 
monial wine (6 per cent, ), sweet spirits of nitre and water ; dose f^ss 
(15.0). Compound liquorice powders (containing sulphur and senna, 
— used as a laxative), have been previously mentioned. 

Cetraria. — Cetraria islandica, or Iceland moss {Nat. Ord. 
Lichenes), is a lichen growing in the northern portions of both 
continents. It contains lichenin and a bitter principle, cetrarin, and 
is used as a demulcent. A decoction (decoctrum cetrarice) is official. 

Chondrus. — Chondrus crispus, Irish Moss, or Carrageen {Nat. 
Ord. Algae), is a marine plant found on the coast of Ireland and 
New England. It contains carragecnin, etc., and is used as a nutri- 
tive (in the form of a blance-mange), as a demulcent, and locally 
as an emollient poultice. 

Amylum (starch). — This is the fecula of the seed of Zea mays 
[Nat. Ord. Grarninaceae). With iodine its solution forms a rich 
blue iodide. It is converted into glucose in the alimentary canal, 
and thus absorbed. It is used as an article of diet and locally as a 
dusting powder. Its solution is employed as a vehicle for laudanum 
enemata. 

Glyceritum amyli {glycerite of starch or plasmine) is used as a 
vehicle for astringent applications to the eye, and as an unguent in 
scarlatina aud smallpox. 

Lycopodium, the sporules of L. clavatum, or club-moss and other 
species of lycopodium {Nat. Ord. Lyeopodiaceae), is used as a 
dusting powder for intertrigo, and is very useful in children with 
excoriated nates. 

Ichthyocolla (isinglass) is prepared from the swimming bladder 
of Acipenser Huso (the sturgeon) and other species. ( Class, Pisces ; 
Ord. Sturiones). It is the purest form of gelatine, and is chiefly 
used locally as a plaster {emplastrwm ichthyocolla — court-plaster). 
Gelatine is also used as an article of diet, and in the form of capsules 
for administering other medicines. 



ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 



Class IV.— Emollients. 

What are emollients ? 

Emollients are bland, fatty substances used externally to soften 
the skin and render it more pliable or to serve as a vehicle for other 
medicaments. 

Describe the emollients. 

Adeps (lard), the prepared internal fat of the abdomen of Sus 
Scrofa (the hog), consists of olein and stearine, and is used in the 
preparation of unguents. Ointment (unguentum) consists of lard 
(80 per cent. ) melted with yellow wax. Cerate (ceratum) contains 
70 per cent, of lard and 30 per cent, of white wax. Adeps (benzoin- 
ated lard) contains 2 per cent, of benzoin to prevent rancidity. 

Adeps Lan^ Hydrosus (hydrous wool-fat — lanolin) is the puri- 
fied fat of the wool of sheep (Ovis Aries) mixed with not more than 
30 per cent, of water. 

Sevum (suet), the internal fat of the abdomen of Ovis Aries (the 
sheep), consists, when purified, almost entirely of stearine. 

Cetaceum (spermaceti), a peculiar, concrete, fatty substance 
obtained from Physeter macrocephalus or sperm-whale. A cerate 
(ceratum cetacei) is official, and it also enters into the preparation of 
cold cream. 

Cera Flava (yellow) and Cera Alba (ivhite wax). The former 
is a peculiar, concrete substance, prepared by Apis mellifica, or 
honey bee. The latter is the former which has been bleached. 
They are used in making cerates, plasters, and ointments. 

Acidum Oleicum (oleic acid), used chiefly in preparing the ole- 
ates of mercury and veratrine. 

Glycerinum (glycerin) is the hydrate of glyoeril and exists in 
animal oils combined with fatty acids. Internally it is nutrient, 
demulcent, and, in large doses, laxative. Administered by the 



EMOLLIENTS. 267 

bowel it is laxative even in small amounts, for which purpose the 
suppositories (suppositoria glycerini) are much used. Locally, it is 
much used as an emollient. Glyceritum Vitelli (glycerite of yolk of 
egg) is used in making emulsions. Glycerite of starch (v. ' ' Amylum ") 
is used externally. 

The gJycerites of carbolic acid, of tannic acid, of boroglycerin, 
and of Hydrastis are also official. 

Oleum Theobromatis (oil of theobroma) or cacao-butter, is the 
fixed oil expressed from the seed of Theobroma Cacao (Nat, Ord. 
Sterculiacese), and is used as an unguent and to give form and con- 
sistence to suppositories. 

Oleum GrOSSYPii Seminis (cottonseed oil), a fixed oil expressed 
from the seed of Gossypium herbaceum (q. v.), is used as a substi- 
tute for almond or olive oil, and enters into the composition of 
numerous liniments. 

Oleum Sesami (oil of sesamum — oil of benne) is & fixed oil ex- 
pressed from the seed of Sesamum indicum (Nat. Ord. Pedaliacese). 
It is used for the same purposes as cottonseed oil. 

Petrolatum Molle (soft petrolatum) is a mixture of hydrocar- 
bons, chiefly of the marsh-gas series, obtained by distilling off the 
lighter and more volatile portions from petroleum and purifying the 
residue. 

It differs from Petrolatum Liquidum (liquid petrolatum) and 
from Petrolatum Spissum (hard petrolatum) chiefly in its consist- 
ence, in its melting-point, and in its specific gravity. The latter is 
of the consistence of cerate, and the former that of an oil, while 
soft petrolatum more nearly approaches that of an ointment. 
Under the names of vaseline and cosmoline, the heavier petroleum 
oils are much used externally as emollients and as a basis for oint- 
ments, and internally to allay irritation of the mucous membranes. 

Many of the "Demulcents'" also are employed in the form of 
poultices as emollients. 



268 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 



Class V.— Protectives. 

What are protectives? 

Protectives are substances used to exclude light or air from the 
surface to which they are applied, or otherwise to protect it from 
injurious influences. Many surgical appliances are thus "protect- 
ives, ' ' but do not belong to the domain of ' ' Materia Medica. ' ' The 
plasters and unguents, when simply used to protect the surface, 
come under this class. The following agents have not been pre- 
viously considered : Collodion, solution of gutta-percha and solution 
of sodium silicate. 

What are these substances ? 

Calcii Sulphas Exsiccatus (dried gypsum, dried calcium sul- 
phate or plaster of Paris) is a powder containing about 95 per cent., 
by weight, of calcium sulphate. 

It is used as a permanent dressing in the treatment of fractures, 
caries of the vertebrae, etc., where it is necessary to give continual 
support to the parts for some time. For this purpose it is moistened 
and thoroughly rubbed into successive layers of previously moist- 
ened roller bandage. It sets very rapidly, forming with the band- 
age a stiff, board-like support. 

Collodium {collodion) is a solution of pyroxylin or soluble gun- 
cotton (pyroxylinum) (4 per cent ), in stronger ether and alcohol. 
When applied to the skin, the solvents rapidly evaporate, leaving a 
colorless, transparent, flexible and strongly contractile film, closely 
adherent, difficult to detach, and impervious alike to air and water. 
It has been used in surgery as an antiphlogistic in inflammation, on 
account of its contractile power, and also applied on gauze, as a sub- 
stitute for adhesive plaster in the treatment of wounds. Its con- 
tractile power is an objection to its use as a simple protective, for 
which purpose it is better to employ flexible collodion (collodium 
flexile), which contains Canada turpentine (5 per cent.) and castor 
oil (3 per cent.), and is more pliable and elastic. Styptic collodion 
(collodium stypticum) contains, in addition to collodion, tannic acid 
(20 per cent.), ether (25 per cent.), and alcohol (5 per cent.). 



COLORING AGENTS. 269 

Elastica {India rubber or caoutchouc) is the prepared milk-juice 
of various species of Hevea {Nat. Ord. Euphorbiaceae), known in 
commerce as Para Rubber. It is used in making plasters, bougies, 
etc., and has been used dissolved in commercial chloroform as a 
protective to small abrasions, chaps, threatened bedsores, etc. 

Liquor Sodii Silicatis {solution of sodium silicate), commonly 
called solution of soluble glass, is principally used in the treatment 
of fractures, applied on successive layers of roller bandage as a 
permanent dressing. 



Class VI.— Coloring Agents. 

What are coloring agents ? 

They are employed almost exclusively to give their particular coloi 
to tinctures, spirits and ointments, and are — 

Coccus {cochineal), the female dried insect. Coccus cacti, a native 
of Mexico and Central America, containing carminic acid, to which 
it owes its peculiar red color. It has been used also as an antispas- 
modic; dose gr. i (0.02), t. i. d. 

Crocus {saffron), the stigmas of Crocus sativus {Nat Ord. 
Irideae), contains safraniu. A tincture {tinctura croci) is official. 

Santalum Rubrum {red saunders), the ivood of Pterocarpus 
santalinus {Nat. Ord. Leguminosse), contains sandal, santalic acid, 
and pterocarpin , and is used to give a red color to pharmaceutical 
preparations. 



INDEX. 



Absinthium, 40 
Acacia, 263 

mucilage of, 263 

syrup of, 263 
Aceta, 22 
Acetauilid, 80, 81 
Acetanilidum, 80, 81 
Acetic acid, 168 
diluted, 168 
glacial, 168 
Acetpheuetidin, 81 
Acetum opii, 91 

scillae, 208 
Acid nitrate of mercury, 63 
Acids, 168, 169 
Acidum aceticum, 168 
dilutum, 168 
glaciale, 168 

arsenosum, 69, 261 

benzoicum, 252 

boricum, 219,250 

carbolicum, 250, 251 

citricum, 168, 169 

gallicum, 230 

hydrobromicum dilutum, 99 

hydroehlorieum, 58 

hydrocyanicum dilutum, 139, 111 

lii'cticum, 59 

nitricum, 57 

nitrohvdrochloricum, 58 

oleicum, 266 

phosphoricum, 58 

sulphuricum, 57 

sulphiirosum, 248 

tannicum, 229 

tartaricum, 169 
Aconine. 162 
Aconite, 162-161, 218 

preparations and doses of, 163, 164 
Aconitine, 162-164 
Aconitum, 162, 164 
Adeps, 265 

benzoinatus, 226 

lanee hydrosus, 266 
Administration of medicines, 32 
Adonidin, 156, 157 
iEther, 116-119, 149 

fortior, U.S. P. 1880, 119 

preparations of, li'j 
Alcohol, 116-149 

absolutum, 148 

official preparations, 148, 149 



Alcoholic extract of belladonna 

leaves, 110 
Alkaloids, cinchona, 42, 46 
Allium, 225 
Allspice, 184 

Allyl, sulphocyanide, 256 
Almonds, preparations of, 142 
Aloe purificata, 192 
Aloes, 192 

pills of asafcetida and, 128 
Aloin, 192 
Aloinum, 192 
Alteratives, 59-77 
Althea, 264 
Alum, 181, 236, 262 
A lumen, 181,236 
Alumina sulphas, 236 
Aluminum sulphate, 236 
Amidophenacetin, 81, 82 
Ammonia, 151, 242, 257 

gas, 149 

liniment, 257 

stronger water of, 259 
Ammoniac, 222, 226 
Ammoniacum, 226 
Ammoniated glycyrrhizin, 265 

mercury, 63 

tincture of guaiac, 75 
Ammonii benzoas, 252 

bromidum, 99 

carbonas, 151 

chloridum, 72, 73, 223 

iodidum, 66 

valerianas, 127 
Ammonium, 149, 151 

acetate, solution of, 219 

benzoate, 252 

carbonate, 151 

chloride, 72, 73, 222, 223 

iodide, 66 

muriate, 223 

valerianate, 127 
Amulsum amygdalae, 142 
Amvl nitris, 138, 151 

nitrite, 138, 151 
Amylum, 265, 267 
Anaesthetics. 116, 123 
Anemonic acid, 167 
Anemonii, 167 
Anise, 187 
Anisum, 187 
Anthemis, 39. 41 

271 



272 



INDEX. 



Antifebrin, 80, 81 
Antimonial ointment, 269 

powder, 161 
Antimonii et potassii tartras, 161, 181 

oxidnm, 161 

sulphidum, 162 

sulphidum purificatum, 162 

sulphuratum, 162 
Antimonium, 159, 162 

and potassium tartrate, 161, 181 
Antimonious oxide, 161 

sulphide, 162 
Antimony, 159, 162 
Antipyretics, 77, 89 
Antipyrine, 78, 80, 116 
Antispasmodics, 126, 130 
Apiol, 177 
Apocynnm, 210 
Apomorphine, 222 

hydrochlorate, 179, 180 
Apothecaries' measure, 24 

relation of, to metrical system, 25 

weight, 23 
relation of, to metrical system, 25 
Approximate measurements, 26 
Aqua, 262 

ammonite, 151 
fortior, 151, 259 

amygdalse, 144 

anisi, 187 

aurantii florum fortior, 187 

camphi/tte, 129 

chloroformi, 121 

cinnamomi, 184 

creosoti, 252 

destillata, 263 

fceniculi, 187 

hydrogenii dioxidi, 244, 245 

menthse piperita?, 186 
viridis, 186 

pagliarii, 236 

rosse, 232 
Aquse, 21 
Arbutin, 212 
Argenti cyanidum, 141, 240 

iodidum, 240 

nitras, 240 
dilutus, 240 
fusus, 240 

oxidum, 240 
Argentum, 239, 240 
Arnica, effects and uses of, 167 

flowers, tincture of, 167 

fluid extract of, 167 

plaster of, 167 

root, extract of, 167 

tincture of, 167 
Arnicin, 167 
Aromatic bitters, 39-41 

preparations and doses of, 41 

elixir, 188 

powder, 185 

spirit of ammonia, 151 

sulphuric acid, 57 
Arsenic, 67-70 



Arsenic iodide, 69 

preparations and doses of, 69 

symptoms and treatment of poison- 
ing by, 68, 69 
Arseni iodidum, 69 
Arsenous acid, 69, 261 
Arsenum, 69-70 
Asafoetida, 127, 128 

emulsion of, 128 

pills of, 128 

pills of aloes, etc., 128 

preparations and doses of, 128 

tincture of, 128 
Asclepias, 222, 224 

fluid extract of, 224 
Aspidium, 200 
Aspidosperma, 224 

fluid extract of, 224 
Atropinse, 152 
Atropine, 107-110, 152, 220 

sulphas, 110 

treatment of poisoning by, 108, 109 
Aurantii amari cortex, 187 

dulcis cortex, 187 
Auri et sodii chloridum, 64 
Aurum, 64 

Balsam of fir, 214 

Peru, 227 

tolu, 222, 227 
Balsamum peruvianum, 227 

tolutanum, 222, 227 
Bark of cotton root, 173, 174 
Basham's mixture, 50 
Belladonna, 107, 110 

liniment of, 110 

ointment of, 110 

plaster of, 110 

root, fluid extract of, 110 

tincture of, 110 

treatment of poisoning by, 108, 109 
Benne, oil of, 267 
Benzoic acid, 226, 252 
Benzoin, 222, 226 

compound tincture of, 226 

tincture of, 226 
Benzoinated lard, 226, 266 
Benzoinum, 226 
Berberine, 37, 39, 46 
Beta-naphtol, 243 
Bismuth, 240, 244 

and ammonium citrate, 241 

subcarbonate, 241 

subnitrate, 241 
Bismuthi et ammonii citras, 241 

subcarbonas, 241 

sub nitras, 241 
Bismuthum, 240, 241 
Bitter almond, water of, 141 
essence of, 142 
spirits of, 141, 142 

tonics, 37 

wine of iron, 51 
Bitters, 37-39 

aromatic, 39-41 



INDEX. 



273 



Bitters, peculiar, 42-47 

simple, 37-39 
Black draft, 193 

drop, 94 
Blaud's pills, 49 
Blue gum tree, 39 

mass, 61, 62, 193 

ointment, 62 

stone, 237 

vitriol, 237 
Borax, 249, 250 
Boric acid, 249, 250 
Brandy, 148 
Brayera, 201 
Bromide of ammonium, 99 

calcium, 99 

potassium, 99 

sodium, 99 

strontium, 99 

zinc, 99 
Bromides, 98, 99, 136 
Bromine, 246 
Bromoform, 123 
Bromum, 246 
Brown mixture, 265 
Brucine, 131 
Bryonia, 196 
Brvony, 196 
Buchu, 211 

fluid extract of, 211 
Burdock, 77 

Burgundy, 257 nn 

Burnett's disinfecting fluid, 238 
Butyl chloral hydrate, 97 

Caffeina, 155, 156 

citrata, 156 

effervescens, 156 
Caffeine, 155, 156, 208 

administration of, 156 

citrated, 156 
effervescent, 156 
Cajuput, oil of, 185 
Calamus, 185 

fluid extract of, 185 
Calcii hromidum, 99 

carbonas praecipitatus, 243 

chloridum, 72 

hypophosphis, 72 

phosphas pnecipitatus, 72 

sulphas exsicoatus, 268 
Calcined magnesia, 194 
Calcium. 243 

chloride, 72 

hypophosphite, 72 

phosphate, 71, 72 

sulphate, dried,. 268 
Calendula, 76 

tincture of, 76 
Calomel, 62, 139, 211 
Calumba, 37, 38, 39 
Calumbo, 38, §9 
Calx chlorata, 246 

sulphurata, 249 
Camhogia, 197 

18 



Campeachy wood, 232 
Camphor, 128, 129 

cerate, 129 

liniment, 129 

monobromated, 129 

preparations and uses of, 129 

spirit of, 129 

Avater of, 129 
Camphora, 128, 129 

monobromata, 129 
Camphorated tincture of opium, 94 
Canada balsam, 214 
Canadensis, 46 
Cannabis Indica, 104, 105 
extract of, 105 
fluid extract of, 105 
tincture of, 105 
Cantharidal collodion, 259 
Cantharides, 177, 217, 258, 259 

tincture of, 217, 259 
Cantharis, 217, 258, 259 

vesicatoria, 258 

vittata, 259 
Caoutchouc 269 
Capsicum, 183, 257 

fluid extract of, 183 

oleoresin of, 183 

plaster of, 183 

tincture of, 183 
Capsules, 23 
Caraway, 187 
Carbolic acid, 250, 251 
crude, 251 
glycerite of, 251 
ointment of, 251 
Cardamom, 185 

compound tincture of, 185 

tincture of, 185 
Cardamomum, 185 
Carica papaya, 35 
Carrageen, 265 
Carron oil, 243 
Carum, 187 
Caryophyllus, 184 
Cascara saerrada, 189 
Cascarilla, 39 
Cassia cinnamon, 183, 184 

fistula, 189 
Castanse, 233 

fluid extract of, 233 
Castor oil, 189, 190, 191 
Catechu, 231 

compound tincture of, 231 

troches of, 231 
Caustic soda, 242, 261 
Celandine, 197 
Centimeter, 24 
Cera alba, 266 
Cera flava, 266 
Cerata, 21 
Cerates, 20, 21 
Ceratum camphorse, 129 

cantharidis, 259 

cetacei, 266 

plumbi subacetatis, 235 



274 



INDEX. 



<1 



Cerii oxalas, 241 
Cerium oxalate, 241 
Cetaceum, 266 
Cetraria, 26-3 

islandica, 265 
Chalk, 243 
compound powder, 243 
mixture, 213 
prepared, 243 
troches of, 243 
Chamomile, 39 

German, 3D 
Charta potassii nitratis, 205 
Charta sinapis, 257 
Chartae, 20 
Chelidonium, 197 
Chenopodium. 200 

oil of, 200 
Chian turpentine, 214 
Chimaphila, 212 

fluid extract of, 212 
Chinoline, 89 
Chirata, 37, 39 
Chiratee, 39 
Chittem bark, 189 
Chloral, 95-97, 136 

treatment of poisoning by, 96 
Chloralamide, 97 
Chloralose, 97, 98 
Chlorinated lime, 246 

soda, solution of, 247 
Chlorine-water, 245, 246 
Chloroform, 119-121 

emulsion of, 121 

liniment of, 121 

preparations of, 121 

spirit of, 121 

water, 121 
Chloroformum, 119-121. 
Choline, 106 
Chondrus, 265 
Cimicifuga, 158, 159 

extract of, 159 

fluid extract of, 158 

tincture of, 159 
Cinchona, 42-46 

administration of, 46 

alkaloids, 42-46 

calisaya, 42 

chemical constituents of, 427 

condaminea, 42 

infusion of, 45 

micrantha, 42 

pallida, 42 

succirubra, 42 
Cinchonicine, 43 
Cinchonidinse sulphas, 45 
Cinchonidine, 42 

sulphate, 45 
Cinchonse sulphas, 45 
Cinchonine, 42 

sulphate, 45 
Cinnamomum cassia, 183, 184 

saigonicum, 183 

zeylanicum, 184 



Cinnamon, 183, 184 

oil of, 184 

spirit of, 184 

tincture of, 184 

water of, 181 
Citric acid, 168, 169 

syrup of, 169 
Citrine ointment, 63 
Classification of medicines, 33 
Cloves, 184 

oil of, 184 
Coca, 113-115 

preparations and doses of, 115 
Cocaine hydrochloras, 115 
Cocaine, 114, 124, 125 
hydrochlorate, 115 

treatment of poisoning by, 114, 115 
Coccus, 269 
Cochineal, 269 
Codeine, 95 
Cod-liver oil, 70, 71 

dose and administration, 71 
Colchicia, 73 
Colchicine, 73, 74 
Colchicum, 74 

fluid extract of; 74 

preparations and doses of, 74 

root, extract of, 74 
fluid extract of, 71 
Cold cream, 232 
Collodion, flexible, 268 

styptic, 268 
Collodium cantharidatum, 259 

flexile, 268 

stvpticum, 268 
Colocynth, 197 
Colocynthis, 197 
Compound cathartic pills, 198 

decoction of sarsaparilla, 75 

effervescing powder, 195 

fluid extract of sarsaparilla, 75 

glycyrrhiza mixture, 265 

liquorice powders, 265 

pills of antimony, 162 

powder of morphine, 94 

solution of iodine, 66 

syrup of sarsaparilla, 75 
squill, 161 
Confectio rosse, 232 

sennpe, 193 
Confectiones, 20 
Confections. 20 
Conium, 143-144 

extract of, 143 

fluid extract of, 144 

preparations and doses of, 143, 144 
Conserves, 20 
Convallamarin, 159 
Convallaria, 159 

fluid extract of, 159 
Convallarin, 159 
Conydrine, 143 
Copaiba, 216 

massa, 216 

oil of, 216 



INDEX. 



275 



>er, 237 

sulphas, 181 

sulphate, 237, 262 
Copperas, 49 
Coriander, 187 
Coriandrum, 187 
Cornutin, 171 
Corrosive sublimate, 60, 61, 211 

treatment of poisoning by, 61 
Cotton bark, 174 

fluid extract of, 174 

root, 173, 174 
Cottonseed oil, 267 
Court-plaster 265 

Cowling's rule for dose in children, 31 
Coxe's hive-syrup, 161, 208 
Cream of tartar, 195, 205 
Cremor tartari, 195 
Creosote, 252 

water, 252 
Creosotum, 252 
Cretan pra?parata, 243 
Crocus, 269 

tincture of, 269 
Croton chloral hydrate, 97 

eluteria, 39 

oil, 198, 260 
Cubeb, 216 
Cubeba, 216 

fluid extract of, 217 

oil of, 217 

oleoresin of, 217 

tincture of, 217 

troches of, 217 
Cubebin, 216 

acid, 216 
Cupri sulphas, 181, 237 
Cuprum, 237 
Curare, 144 
Curarine, 144 
Cusso, 201 
Cyan ids, 141 
Cvpripedium, 130 

"fluid extract, 130 

Daturine, 111 
Decimal system, 24, 25 

relation to apothecaries' weight and 
. measure, 25, 26 

weights and measures, 24,25 
Decoeta, 22 
Decoctions, 20, 22 
Decoctum cetraria?, 265 

sarsaparilla? compositum, 75 
Definitions, 18-23 
Depresso-motors, 134, 145 
Diachvlon ointment, 235 
Digallic acid, 229 
Digestants, 35, 37 
Digitalein, 152 
Digitalin, 152 
Digitalis, 152-154, 208 

extract of, 154 

fluid extract of, 154 

infusion of, 154 



Digitalis, preparations of, 154 

tincture of, 154 
Digitalosmin, 152 
Digitin, 152 
Digitonin, 152 
Digitoxin, 152 
Diluted hydrobromic acid, 99 

hvdrocvanic acid, 139-141 
Diohal, 100 
Dispensatory, 19 
Donovan's solution, 69 
Dosage, 29-32 
Dover's powder, 94, 218 
Dried gypsum, 268 
Duboisia, 113 
Duboisine, 113 
Dulcamara, 77 

fluid extract of, 77 

Effervescent magnesium citrate, 194 

Effervescing draught, 204 

Elastica, 269 

Elaterin, 198 

Elaterinum, 198 

Elixir aromaticum, 188 

phosphorii, 55 

phosphorus, 55 

vitriol, 57 
Ellis' magnesia, 194 
Elm, 264 
Emetine, 178 
Emplastra, 21 

Emplastrum, ammoniaci cum hydrar- 
gyri, 62, 226 

arnica?, 167 

belladonna?, 110 

capsici, 183 

ferri, 49 

hydrargvri, 62 

ichthyocollse, 265 

opii, 94 

picis cum cantharide, 258 
burgundicse, 258 

plumbi, 235 

saponis, 235 
Emulsa, 23 

Emulsion of almonds, 263 
Emulsions, 23 
Emulsum, ammoniaci, 226 

amygdalae, 263 

asa'feetida, 128 

chloroformi, 121 
Enemata, 23, 199 
Epsom salt, 194 
Ergot, 170, 173 

extract of, 172 

fluid extract of, 173 

preparations and doses of, 172, 173 

wine of, 173 
Ergota, 170, 173 
Eriodictvon. 222, 22.") 

fluid extract of, 225 
Erythema. 44 
Erythroxylon, 113 

fluid extract of, 115 



276 



INDEX. 



Ether, 116-119, 130 
compound spirit of, 130 
preparations of, 119 
spirit of, 119 
Ethereal oil, 130 
Ethyl bromide, 122, 123 
chloride, 124 
hydrate, 146 
nitrite, 219 
oxide, 116-119 
Eucaine, 125 
Eucalyptol, 41 
Eucalyptus, 39, 41, 222, 228 

fluid extract of, 41 
Euonymus, 193 
Eupatorium, 39 

fluid extract of, 41 
Excito-motors, 130-134 
Extracta, 20 
fluida, 22 
Extracts, 20 
fluid, 20-22 
Extractum aconiti, 163 
fluidum, 163 
aloes, 192 

apocyni fluidum, 210 
arnicae radicis, 167 

fluidum, 167 
aromaticum fluidum, 185 
asclepiadis fluidum, 224 
aspidospermatis fluidum, 224 
aurantii amari fluidum, 188 

dulcis fluidum, 188 
belladonna; foliorum alcoholicum, 
110 
radicis fluidum, 110 
buchu fluidum, 211 
calami fluidum, 185 
cannabis indicae, 105 

fluidum, 105 
capsici fluidum, 183 
castame fluidum, 233 
chimaphihe fluidum, 212 
cimicifugae, 159 

fluidum, 158 
cinchonas, 45 
fluidum, 45 
coca? fluidum, 115 
colchici radicis, 74 
fluidum, 74 
seminis fluidum, 74 
colocynthidis, 197 
compositum, 197 
conii, 143 

fluidum, 144 
convallarise fluidum, 159 
cubebae fluidum, 217 
cusso fluidum, 201 
cypripedii fluidum, 130 
digitalis, 154 

fluidum, 154 
dulcamara; fluidum, 77 
crgotae, 173 

fluidum, 174 
eriodicyti fluidum, 225 



Extractum eucalypti fluidum, 41 
euonymi, 193 
eupatorii fluidum, 41 
frangulse fluidum, 189 
gelsemii fluidum, 139 
geranii fluidum, 232 
glycyrrhizse, 264 

fluidum, 264 

purum, 264 
gossypii radicis fluidum, 174 
grindeliae fluidum, 222 
guaranae fluidum, 156 
haematoxyli, 232 
hamemelidis fluidum, 232 
hydrastis fluidum, 47 
hyoscyami, 112 

fluidum, 112 
ipecacuanhas fluidum, 179 
iridis, 197 

fluidum, 197 
jalapae, 196 
juglandis, 192 
krameriae, 231 

fluidum, 231 
lappae fluidum, 77 
leptandrae, 193 

fluidum, 193 
lobelia; fluidum, 142 
lupulini fluidum, 106 
matico, 217 

menispermi fluidum, 76 
mezerei fluidum, 76 
nucis vomicae, 133 

fluidum, 133 
opii, 93 

pareirse fluidum, 212 
physostigmatis, 136 
pilocarpi fluidum, 221 
podophylli, 196 

fluidum, 196 
pruni virginianae fluidum, 41 
rhamni purshiana fluidum, 189 
rhei, 191 

fluidum, 191 
rhois glabrae fluidum, 233 
rosae fluidum, 232 
sabinae fluidum, 176 
sanguinariae fluidum, 225 
sarsaparillae fluidum, 75 

compositum, 75 
scillae fluidum, 208 
scoparii fluidum, 210 
Scutellariae fluidum, 130 
senegas fluidum, 224 
sennae fluidum, 193 
serpentarise fluidum, 41 
spigelian fluidum, 200 
stillingiae fluidum, 77 
stramonii seminis, 111 

fluidum, 111 
taraxaci, 210 

fluidum, 210 
tritici fluidum, 212 
uvae ursi, 212 
fluidum, 212 



INDEX. 



277 



Extractum Valerianae fluidum, 127 
veratri viridis fluidum, 165 
viburnum fluidum, 175 
zere fluidum. 214 
zingiberis fluidum, 185 

Fennel, 186 

Ferri carbonas saccharatus, 49 
chlorklum, 50 
citras, 50 

et ammonii citras 51 
sulphas, 51 
tartras, 51 
potassii tartras, 51 
quininae citras, 51 

solubilis, 51 
strychnine citras, 51 
hypophosphis, 50 
iodidum saccharatum, 50 
lactas, 51 

oxidum hydratum, 49 
cum magnesia, 49 
phosphas solubilis, 50 
pyrophosphas, 50 
sulphas, 49 
exsiccatus, 49 
granulatus, 49 
valerianas, 51 
Ferric ammonium sulphate, 51 
chloride, 50 
citrate, 50 
hypophosphite, 50 
valerianate, 51 
Ferrous carbonate, mass of, 49 
iodide, pills of, 50 
lactate, 51 
sulphate, 49 
dried, 49 
granulated, 49 
Ferrum, 47-52 
reductum, 49 
Flaxseed, 264 

tea, 264 
Flower of sulphur, 190 
Fluid extracts, 20, 22 
Foeniculum, 187 
Fomentations, 23 
Formaldehyd, 254 
Formalin, 2")} 
Formic aldehyd, 254 
Formyl terchloride, 119 
Fowler's solution, 69 
Frangula, 189 

Galla, 231 
ointment of, 231 

tincture of, 231 . 
Gallic acid, 230 
Gallo-tannic acid, 229 
Gamboge, 197 
Gargles, 23 
Garlic, 222, 225 
Gaultheria, 186 

oil of, 186 

spirit of, 186 



Gelatine, 265 
Gelsemine, 138 
Gelseminic acid, 138 
Gelseminine, 138 
Gelsemium, 138, 139, 166 

fluid extract of, 139 

preparations and doses of, 139 

tincture of, 139 
Gentian, 37, 38, 39 
Gentiana, 37 
Gentianse, 38 
Gentisic acid, 37 
Gentisin, 37 
Geranium, 232 

fluid extract of, 232 
Ginger, 184, 185 

fluid extract of, 185 

oleoresin of, 185 

syrup of, 185 

tincture of, 185 

troches of, 185 
Glauber's salt, 194, 195 
Glycerin, 266, 267 
Glycerinum, 266, 267 
Glycerita, 22 

Glycerite of boroglycerin, 250, 267 
of carbolic acid, 267 
glyceryl borate, 250 
hydrastis, 267 
starch, 267 

or plasm ine, 265 
tannic acid, 267 
yolk of egg, 267 
Glyce rites, 20, 22 
Glyceritum acidi carbolici, 251 
tannici, 230 

amyli, 265 

boroglycerini, 250 

hydrastis, 47 

vitelli, 267 
Glycyrrhiza, 264 

extract of, 264 

fluid extract of, 264, 265 

refined extract of, 264 

troches of opium and, 94 
Glycvrrhizinum ammoniatum, 265 
Gold, 64 

and sodium chloride, 64 

preparations and doses of, 64 

salts, 64 
Golden seal, 46 

Gossypii radicis cortex, 173, 174 
Goulard's extract, 235 

cerate, 235 
Gramme, 24 
Granatum, 200 
Granules, 23 

(rranville's vesicating lotion, 259 
Gray powder, 62 
Green vitriol, 49 
Griffith's anti-hectic mixture, 49 
Grindelia,2 22 

fluid extract of, 222 
Grondret's vesicating ointment, 259 
Guaiac, 75, 177 



278 



INDEX. 



Guaiac acid, 75 

beta-resin, 75 

preparations and doses of, 75 

resina, 75 

wood, 75 

yellow, 75 
Guaiaci lignum, 75 
Guaiacin, 75 
Guaiacol, 86, 88, 126 

carbonate, 86-88 
Guaiaconic acid, 75 
Guarana, 156 

fluid extract of, 156 
Gum arabic, 263 
Gypsum, dried, 268 

HiEMATOXYLON, 232 

extract of, 232 
Hamamelis, 232 

fluid extract of, 232 
Hedeoma, 186 
Henry's magnesia, 194 
Hoffmann's anodyne, 130 
Homatropine hvdrobromate, 110 
Honey, 20, 22 

Hope's campbor mixture, 129 
Horebound, 186 
Humulus, 106 

tincture of, 106 
Husband's magnesia, 194 
Hydrargyri chloridum corrosivum, 
62, 63, 246, 261 
mite, 62, 193, 201 

cyanidum, 63 

iodidum flavum, 63 
rubrum, 63, 246 

oxidum flavum, 62 
rubrum, 62 

subsulphas flavus, 63, 181 
Hydrargyrum, 60-64 

ammoniatum, 63 

cum cretpe, 62 

preparations and doses of, 61-63 
Hydrastine, 46 

Hydrastinime bydrocbloras, 47, 173 
Hydrastinine bvdrochlorate, 47, 173 
Hydrastis, 42, 46, 45, 173 

fluid extract of, 47 

glycerite of, 47 

preparations and doses of, 47 

tincture of, 47 
Hydrate, 222 
Hydrated ferric oxide, 49 

witb magnesia, 49 
Hydrochloric acid, 56, 58 
diluted, 58 

ether, 124 
Hydrocyanic acid, 139, 141 
Hydrogen dioxide, solution of, 244, 245 

peroxide, 244, 245 
Hydroquinone, 88, 89 
Hydrous wool-fat, 266 
Hyoscinee hydrobromas, 100 
Hyoscine hydrobromate, 100 
Hyoscyaminse hydrobromas, 113 



Hyoscyaminfe sulphas, 112, 113 
Hyoscyamine hydrobromate, 113 

sulphate, 112, 113 
Hyoscyam.ua, 111, 113 

extract of, 112 

fluid extract of, 112 

preparations and doses of, 112, 113 

tincture of, 112 
Hypnotics, 90-106 
Hypophosphites, 71, 72 

preparations and doses of, 72 

Iceland moss, 265 
Ichtbyocolla, 265 
Igasuric acid, 131 
Igasurine, 131 
Illicum, 187 
India rubber, 269 
Indian cannabis, 104, 105 

preparations and doses, 105 
Infusa, 22 
Infusions, 20, 22 
Infusum cinchonoe, 45 

digitalis, 154 

pruni virginianse, 41 

sennse composituni, 193 
Ingluvin, 35, 36 
Inhalations, 23 
Injections, 23 
Iodides, 65-67 

preparations and doses of, 66, 67 
Iodine, 65-67, 246 

ointment, 66 

preparations and doses of, 66, 67 

treatment of poisoning by, 65 
Iodoform, 247. 248 

ointment, 247 
Iodoformum, 247, 248 
Iodol, 248 
Iodum, 65-67, 246 
Ipecac, 178,218,222 

fluid extract of, 179 

powder of opium and, 90, 179 

preparations and doses of, 179 

syrup of, 179 

tincture of opium and, 90, 179 

troches of, 179 
Ipecacuanha, 178, 179 

preparations and doses of, 179 
Ipecacuanhic acid, 179 
Iris, 197 

extract of, 197 

fluid extract of, 197 
Irish moss, 265 
Iron, 47-52 

and ammonium tartrate, 51 
citrate, 51 
potassium tartrate, 51 
quinine citrate, 51 
strychnine citrate, 51 

carbonate, pills of, 49 

compound mixture of, 49 

plaster of, 49 

preparations and doses of, 49-51 

reduced, 49 



INDEX. 



279 



Iron sulphate, 39 

therapeutic uses of, 48, 49 

troches of, 40 
Esaconitine, 162 
Isinglass, 265 
Isonaphthol, 253 

Jabokandine, 220 

Jalap, 196 

compound powder of, 196 

extract of, 1% 

resin of, 196 
Jala pa, 196 
James' powder, 161 
Jervine, 164 
Juglans, 191 
Juniper, 213 

compound spirit of, 213 

spirit of, 213 
Juniperus, 213 

Kaibine, so 

Kamala, 201 
Kermes mineral, 162 
Kim., 231 

powder, 231 

tincture of, 231 

tannic acid, 229 
Kousso, 201 
Krameria. 231 

extract of, 231 

fluid extract of, 231 

syrup of, 231 

tincture of, 231 

troches of, 231 

Labarraque's solution, 246 
Lac asafoeticl.se, 12^ 
Lactic acid.-") 1 .) 

preparations and doses of, 59 
Lactucarium,106 

syrup of, 106 

tincture of, 106 
Lady Webster's dinner pills, 192 
Lanolin. 266 
Lappa, 77 

fluid extract of, 77 
Lard. 266 
Laudanum, 94 

Lauder P>runton's rule for dose in chil- 
dren, 31 
Lavender, compound tincture of, 186 

flowers, oil of, 1st', 

spirit of, 186 
Lead. 233, 236 

carbonate, 235, 236 

iodide, 235 

nitrate. 235 

ointment. 235 

oxide. 235 

preparations of. 235 

subacetate, cerate of, 235 
solution of. 235 
diluted, 235 

sugar of, 235 



Ledoyen's disinfecting fluid, 235 
Lemon, essence of, 169 
juice of, 169 
oil of, 169 
spirit of, 169 
Leptandra, 193 
Lime liniment, 243 
solution, 243 
syrup of, 243 
water, 243 
Limonis succus, 169 
Linimenta, 21 
Liniments, 20, 21 
Linimentum ammonias, 257 
belladonnas, 110 
calcis, 243 
eamphorre. 129 
chloroformi, 121 
saponis, 129 

sinapis compositum, 257 
terebinthina;, 216 
Linum, 264 
Liquids, 19, 20 
Liquor acidi arsenosi, 69 
ammonii acetatis, 219 
arseni et hydrargyri iodidi, 69 
ferri acetatis, 50 
chloridum, 50 
citratis, 50 

et ammonii acetatis, 50 
nitratis, 50 
subsulphatis, 50 
tersulphatis, 50 
hydrargyri nitratis, 63, 261 
iodi compositus. 66 
magnesii citratis, 194 
plumbi subacetatis, 235 

dilutus, 235 
potassa?, 204 
potassii arsenitis, 69 

citratis, 204 
soda?, 242 

chloratae, 246 
sodii arsenatis, 69 

silicatis. 269 
zinci chloridi, 239 
Liquorice. 193, 264 
compound powder of, 193 
root, 264 
Liquores, 21 
Litharge, 235 
Lithii benzoas, 206 
carbonas, 206 
citras, 206 
effervescens, 206 
Lithium. 206 
benzoate, 206 
bromide. 206 
carbonate, 206 
citrate, effervescent, 206 
salicylate, 206 
Lobelia. 112. 222 
fluid extract of. 142 
preparations and doses of, 142 
tincture of, 142 



280 



INDEX. 



Lobelic acid, 142 
Lobeline, 142 

Local anaesthetics, 123-126 
Logwood, 232 
London paste, 2G1 
Lotions, 23 
Lozenges, 19, 20 
Lugol's solution, GG, 67 
Lupulin, 106 

fluid extract of, 106 

oleoresin of, 106 
Lupulinum, 106 
Lycopodium, 165 

Mace, 184 
Macis, 184 

Magendie's solution, 94 
Magnesia, 194 

alba, 194 

ponderosa, 194 
Magnesii carbonas, 194 

citras effervescens, 194 

sulphas, 194 
Magnesium carbonate, 194 

citrate, effervescent, 194 
solution of, 194 

sulphate, 194 
Manganese, 52, 53 

dioxide, 53 

preparations and doses of, 53 

sulphate, 53, 195 
Mangani dioxidum, 53 

sulphas, 53, 195 
Manganum, preparations and doses 

of, 52, 53 
Manna, 189 
Marrubium, 186 
Massa eopaibae, 216 

hydrargyri, 61, 62, 193 
Materia raedica, 17 

proper, 17 
Matico, 217 

fluid extract of, 217 

tincture of, 217 
Matricaria, 39, 41 
Measure, wine, 24 
Measurements, approximate, 26 
Measures, 23, 26 
Mellita, 22 
Mel rosae, 232 
Menispermum, 76 

fluid extract of, 76 
Mentha piperita, 186 

viridis, 186 
Menthol, 125, 126 
Mercurial cathartics, 193 

ointment, 62 

oleate, 62 

plaster, 62 
Mercuric chloride, 62, 63, 246, 261 

cyanide, 63 

iodide, 63, 246 
Mercurous chloride, 62, 193 

iodide, 63 
Mercury, 60-64 



Mercury, mass of, 61, 62 

metallic, 60 

preparations and doses of, 61-63 

with chalk, 62 
Methenyl chloride, 119 
Methvl-conine, 143 
Methylene bichloride, 122, 123 
Methylpyrocatechin, 86, 88 
Metrical weights, 24, 25 
Mezereon, 75, 76 

fluid extract of, 76 
Mezereum, 75, 76 
Mineral acids, 55, 59 
names of, 56 
therapeutic uses of, 56 
treatment of poisoning by, 56 

tonics, 47, 59 
Mistura cretse, 243 

ferri composite, 49 

glycyrrhizte compositse, 265 

rhei et soda\ 191 
Misturae, 21 
Mixtures, 20, 21 
Morphinn? acetas, 94 

hydrochloras, 94 

sulphas, 94 
Morphine acetate, 94 

hydrochlorate, 94 

sulphate, 94 

troches of ipecac and, 94 
Moschus, 126, 127 
Mucilago acacia?, 263 

sassafras medullar, 264 

tragacanthse, 264 

ulmi, 264 
Muriatic acid, 58 

diluted, 58 
Musk, 126, 127 

preparations of, 127 

tincture of, 127 
Mustard, 180, 181 

black, 256, 257 

liniment, 257 

papers, 257 

volatile oil of, 257 

white, 256, 257 
Mydriatic anodynes, 107, 116 
Myristica, 184 

Naphtalin, 253 
Naphtalinum, 253 
Naphthalin, 253 
Naphtol, 253 
Neutral mixture, 204 
Nicotianin, 144 
Nicotine, 144 
Nitre, 205 
Nitric acid, 56, 57 

diluted, 57 
Nitrites, 136-138 

preparations and doses of, 138 
Nitrogen monoxide, 122 
Nitroglycerin, 151 

triturates of, 138 
Nitrohydrochloric acid, 56-58 



INDEX. 



281 



Nitrohydrochloric acid, aqua regia, 

diluted, 58 
Nitromuriatic acid, aqua regia, 58 

diluted, 58 
Nitrous oxide, 122 
Nutmeg, 184 
oil of, 184 
spirit of, 184 
Nux vomica, 131-133 

extract of, 133 

fluid extract of, 133 

preparations and doses of, 133 

tincture of, 133 

Official preparations, 19 
Oil of bitter almond, 141 

cade, 227 

erigeron, 213 

gaultheria, 84 

neroli, 187 

orange flowers, 187 

santal, 213 

sweet birch, 84 

thyme, 186 

turpentine, 188, 201, 215, 257 
rectified, 210 

vitriol, 57 

wintergreen, 84 
Ointment, 266 

of ammoniated mercury, 63 

of mercurial nitrate, 63 

of potassium iodide, 66 

of red mercuric oxide, 62 

of vellow mercuric oxide, 62 
Ointments, 20, 21 
Oleata, 21 
Oleate of zinc, 238 
Oleates. 20, 21 
Oleatum hydrargyri, 62 

veratrinae, 166 

zinci, 238 
Oleic acid, 266 
Oleoresina, aspidii, 200 

cubebae, 217 

lupulini, 106 

piperis, 183 

zingiberis, 185 
Oleoresina?., 23 
Oleoresins, 20, 23 
Oleum athereum, 130 

amygdalae amarae, 141 

ani'si, 187 

aurantii corticis, 187 
riorum, 187 

betula volatile, 84 

cadinum, 227 

cajuputi, 185 

cari, 187 

earyophylli, 184 

chenopodii, 200 

cinnamomi, 184 

copaibae, 216 

coriandri, 187 

erigerontis, 213 

fceniculi, 187 



Oleum gaultheriae, 84, 186 

gossypii seminis, 267 

hedeoma, 186 

juniperi, 213 

lavendulae riorum, 186 

limonis, 169 

lini, 264 

menthae piperita, 186 
viridis, 186 

morrhuae, 70, 71 

myristicae, 184 

phosphoratum, 55 

picis liquidae, 227 

ricini, 189 

rosmarini, 186 

sabinse, 176 

santali, 213 

sassafras, 76 

sesami, 267 

sinapis volatile, 257 

terebinthinae, 201, 214, 215 
rectificatum, 216 

thvmi, 186, 254, 255 

tiglii, 198 
Opii emplastrum, 94 

extractum, 93 

pulvis, 93 
Opium, 90, 95, 179 

chemical ingredients, 91 

deodoratum, 93 

deodorized, 93 

extract of, 93 

pills, 93 

plaster, 94 

powdered, 93 

powder of ipecac and, 90, 179 

preparations and doses of, 93, 94 

tincture of ipecac and, 90, 179 

treatment of poisoning by, 92 
Orange, bitter, 187 

compound spirit of, 187 

fluid extract of bitter, 187 

oil of, 187 

spirit of, 187 

syrup of, 187 
Orange flower, stronger water of, 187 
syrup of, 187 
triple water of, 187 
Orange peel, sweet, 187 

tincture of bitter and sweet, 188 
Ovis aries, 266 

Tale rose, 232 

ointment of, 232 

stronger water of, 232 
Pancreatin, 35, 36, 37 
Pancreatinum, 35, 36 
Papain, 35, 36, 37 
Papers, 19, 20 
Paraldehydum, 100 
Pareira, 211 

fluid extract of, 212 
Parillin, 74 
Parvules, 23 
Peculiar bitters, 42-47 



282 



INDEX. 



Pelletierine tannate, 200 
Pennyroyal, 186 
Pepo, 20 
Pepper, 183 

oleoresin of, 183 
Peppermint, 186 

troches of, 186 
Pepsin, 35, 36 
Pepsinum, 35, 36 

saccharatum, 36 
Peruvian balsam, 222 
Petrolatum, liquid, 267 
Petrolatum liquidum, 267 

molle, 267 

spissum, 267 
Pharmocology, 17 
Pharmacopoeia, 19 
Pharmacy, 17 
Phenacetin, 81 

doses of, 81 
Phenic acid, 250 
Phenocoll, 81, 82 
Phenol, 250 

cymylic, 254, 255 
Phosphates, 71, 72 

preparations and doses of, 72 
Phosphide, 72 
Phosphite, 71 
Phosphorated oil, 55 
Phosphoric acid, 56, 58 

diluted, 58 
Phosphorus, - r >3, 55 
- pills of, 55 

preparations and doses of, 55 

tincture of, 55 

toxic effects of, 54 

treatment of poisoning by, 54 

uses of, 54 
Physostigma, 135, 136 

extract of, 136 

preparations and doses of, 136 

tincture of, 136 
Physostigminse salicylas, 136 

sulphas, 136 
Physostigmine salicylate, 136 

sulphate, 136 
Picroconitine, 162 
Picrotoxin, 134 
Picrotoxinum, 134 
Pills, 19, 20 
Pilocarpidine, 220 
Pilocarpine hydrochloras, 221 
Pilocarpine, 222 

hydrochlorate, 221 
Pilocarpos, 220,221 

fluid extract of, 221 

preparations and doses of, 221 
Pilule, 20 

aloes, 192 
et asafcetide, 128, 192 
ferri, 192 
mistaches, 192 
myrrhe, 192 

antimonii compositse, 162 

asafcetide, 128 



Pilule cathartice compositse, 198 
vegitables, 198 

ferri carbonatis, 49 
iodidi, 50 

opii, 93 

phosphori, 55 

rhei, 191 
composite, 197 
Pimenta, 184 

oil of, 184 
Piped n, 183 
Piperinum, 183 

Pitch plaster with cantharides, 258 
Pix burgundica, 257 

liquida, 227 
Plaster of ammoniac with mercury, 6: 

of Paris, 268 
Plasters, 20, 21 
Pleurisy, 224 
Plumbi acetas, 235 

carbonas, 235, 236 

iodidum, 235 

nitras, 235 

oxidum. 2! 5 
Plumbum, 233, 236 
Plummer's pills, 162 
Podophyllotoxin, 196 
Podophyllum, 196 
Pomegranate, 200 
Potassa, 'Jin, 260 

cum calce, 260 

solution of, 204, 242 

sulphurata, 190, 191 

with lime, 260 
Potassii acetas, 204 

bicarbonas, 204 

bicbromas, 262 

bitartras, 195, 205 

bromidum, 99 

chloras, 205 

citras. 204 
effervescens, 204 

cyanidum, 141 

et sodii tartras, 195 

hypophosphis, 72 

iodidum, 66 

nitras, 205 

pernianganas, 53, 245 

sulphas, 195 
Potassio-tartrate of iron, 51 
Potassium acetate, 204 

and sodium tartrate, 195 

bicarbonate, 204 

bichromate, 262 

bitartrate, 195, 205 

bromide, 99 

carbonate, 204 

chlorate, 205 

citrate, 204, 219 
effervescent, 204 
solution of, 204 

cyanide, 141 

hypophosphite, 72 

iodide, 66 

myronate, 256 



INDEX. 



283 



Potassium nitrate, 205 

nitrite, 138 

permanganate, 52, 53, 245 

sulphate, 194 
Potato fly, 259 
Poultices, 23 

Powder of ipecac and opium, 94 
Powders, 19, 20 

Precipitated calcium carbonate, 243 
phosphate, 72 

sulphur, 190 
Preparations, official, 19 
Prepared chalk, 243 
Prescription-writing, 26, 29 
Prunus virginiana, 39, 41, 228 
fluid extract of, 41 
infusion of, 41 
syrup of, 41 
Prussic acid, 139, 141 

treatment of poisoning by, 140 
Pseudoconhvdrine, 143 
Pulsatilla, 167 
Pulveris, 20 
Pulvis antimonialis, 161 

aromaticus, 185 

cretse compositus, 243 

effervescens compositus, 195 

glycyrrhiza? compositus, 193 

ipecacuanha? et opii, 94 

jalapa? compositus. 196 

morphinse compositus, 94 

rhei compositus, 191 
Pumpkin seed, 201 
Pure bitters, 37 

Purified antimonious sulphide, 161 
Pyrocatechin, 88, 89 

Quassia, 37,39 
Quassia?, 38 
Quebracho, 222 
Quercus alba, 232 
Quevenne's iron, 49 
Quicksilver, 60 
Quillaja, 222, 224 

tincture of, 224 
Quinieine, 43 
Quinidinse sulphas, 45 
Quinidine, 42_ 

sulphate, 45 
Quinina?, 174 

bisulphas, 45 

hydrobromas, 45 

hydrochloras, 45 

sulphas, 45 

valerianas, 45 
Quinine, 42, 45, 82, 174 

bisulphate, 45 

hydrobromate, 45 

hydrochlorate 45 

sulphate, 45 

valerianate, 45 

Red r.vrk, 42 
mercuric oxide, 62 
pepper, 183 



I Red precipitate ointment, 62 

rose, 232 
confection, 232 
fluid extract of, 232 
honey, 232 
syrup, 232 

saunders, 269 

wine, 148, 149 
Remedies, 18, 19 

dietetic, 18 

hygienic, 18, 19 

mechanical, 18 

pharmaceutical, 18, 19 

physical, 18 
Resin, 214, 215 
Resina, 214, 215 

ja lapse, 196 

scammonii, 197 
Resorcin, 88, 89 
Resorcinum, 88, 89 
Rhamnus purshiana, 180 
Rheum, 191 
Rhigolene, 124 
Rhubarb, 191 

aromatic tincture of, 191 
syrup of, 191 

compound pills of, 191 

extract of, 191 

fluid extract of, 191 

mixture of soda and, 191 

pills, 191 

sweet, tincture of, 191 

syrup of, 191 

tincture of, 191 
Rhus glabra, 232, 233 

toxicodendron, 133 
Rochelle salt, 195 
Rosa centifolia, 232 

gallica, 232 
Rosemary, oil of, 186 
Rose water, 232 
Rufus pill, 192 

SABINA, 176 

Saccharated ferrous iodide, 50 

pepsin. 36 
Saffron, 269 
Sage, 39 

Saigon cinnamon, 183 
Sal ammoniac, 223 
Salicin, 82-86 

preparations and doses of, 83, 84 
Salic vlas. 84 

lithii, 84 

methyl, 84 

sodii, 84 
Salicylate, 84 

lithium, 84 

methyl, 84 

phenyl, 84 

physostigmine, 84 

sodium, 84 
Salicylates, 82-86 

preparations and doses of, 83, 84 
I Salicylic acid, 82, 84, 219 



284 



INDEX. 



Salicylic acid, preparations and doses 

of, 83, 84 
Salicylicum, 83 

acidum, 83, 84 
Salol, 85 

doses of, 85 
Salophen, 85, 86 
Saltpetre, 205 
Salts of gold, 64 

lead, 39 

silver, 39 
Salvia, 186 
Sanguinaria, 222, 225 

fluid extract of, 225 

tincture of, 225 
Sanguinarine, 225 
Santalum rubrum, 269 
Santonica, 200 
Santonin, 200 

troches of, 200 
Santoninum, 200 
Saponin, 224 
Sarsaparilla, 74, 75 

compound fluid extract of, 75 

fluid extract of, 75 

preparations and doses of, 75 
Sassafras, 76 

medulla, 264 

oil of, 76 

pith, 264 
Savine, 176 

fluid extract of, 176 

oil of, 176 
Scammonium, 197 
Scammony, 197 
Scilla, 207, 208 
Scoparius, 210 
Scutellaria, 130 

fluid extract of, 130 
Seidlitz powder, 195 
Semi-solids, 19, 20 
Senega, 222, 223 

fluid extract of, 224 

syrup of, 224 
Senna, 193 

compound infusion of, 193 
powder of glycyrrhiza and, 193 

confection of, 193 

fluid extract of, 193 

syrup of, 193 
Serpentaria, 39, 41, 222, 228 

fluid extract of, 41 

tincture of, 41 
Sesamum, oil of, 267 
Sevum, 266 
Silver, 239, 240 

cyanide, 141, 240 

iodide, 240 

nitrate, 240, 262 
diluted, 240 
moulded, 240 

oxide, 240 
Simple bitters, 37-39 

preparations and doses of, 38, 39 

syrup, 22 



Sinalbin, 256 
Sinapis, 180, 181 

alba, 256, 257 

nigra, 256, 257 
Sinigrin, 256 
Sinilacin, 74 
Soap liniment, 129 

plaster, 235 
Socotrine aloes, 192 
Soda, 261 

caustic, 242, 261 

solution of, 242 
Sodii acctas, 207, 208 

arsenas, 69 

bicarbonas, 242 

benzoas, 252 

bisulphis, 249 

boras, 249, 250 

bromidum, 99 

carbonas, 242 

exsiccatus, 242 

hypophosphis, 72 

hyposulphis, 249 

iodidum, 66 

nitris, 138 

phosphas, 195 

pyropbosphas, 195 

sulphas, 194, 195 

sulphis, 249 

sulphocarbolas, 251 
Sodio-theobromine salicylate, 208, 209 
Sodium acetate, 207 

arsenate, 69 

benzoate, 252 

bicarbonate, 242 
troches of, 242 

bisulphate, 249 

carbonate, 242 

hypophosphite, 72, 249 

nitrite, 138 

paraphenol sulphonate, 251 

phosphate, 196 

preparations of, 242 

pyrophospbas, 195 

silicate, solution of, 269 

sulphate, 194, 195 

sulphocarbolate, 251 
Soft petrolatum, 267 
Solidified copabia, 216 
Solids, 19 
Soluble ferric phosphate, 50 

iron and quinine citrate, 51 
pyrophosphate, 50 
Solution of ammonium acetate. 219 

of arsenic and mercuric iodide, 69 

of arsenous acid, 69 

of boroglycerite, 250 

of ferric acetate, 50 
chloride, 50 
citrate, 50 
nitrate, 50 
subsulphate, 50 
sulphate, 50 

of iron and ammonium acetate, 50 

of mercuric nitrate, 63, 261 



INDEX. 



285 



Solution of potassium arsenite, 

of sodium arsenate, 69 
silicate, 269 

of zinc chloride, 239 
Solutions, 20, 21 
Spanish fly, 258 
Sparteine sulphas, 157, 210 
Sparteine sulphate, 157 
Spearmint, 186 
Spermaceti, 266 
Sphacelinic acid, 171 
Spigelia, 199 

fluid extract of, 200 
Spirit of glonoin, 138 

of mindererus, 219 

of nitroglycerin, 138 

of nitrous ether, 210, 211, 219 

of phosphorus, 55 
Spirits, 20, 22 
Spiritus, 22 

etheris, 119, 130 
compositus, 130 
nitrosi, 210, 211, 219 

ammoniee, 151 
aromaticus, 151 

amygdalae amarse, 141, 142 

anisi, 187 

aurantii, 187 
compositus, 187 

camphorse, 129 

chloroformi, 121 

cinnamomi, 184 

frumenti, 148 

gaultberiae, 186 

glonoini, 138 

juniperi, 213 
compositus, 213 

lavendulse, 186 

limonis, 169 

myristicse, 184 

ptiosphori, 55 

vini gallici, 148 
Squill, 207, 222, 228 

compound syrup of, 208 

fluid extract of, 208 

syrup of, 208 

tincture of, 208 
Star anise, 187 
Starch, 265 
Stillingia, 76, 77 

fluid extract of, 77 
Stramonium, 111 

fluid extract of, 111 

ointment of, 111 

preparations of, 111 

seed, extract of, 111 

tincture of, 111 
Strontii bromidum, 99 

iodidum, 67 

lactas, 207 
Strontium iodide, 67 

lactate, 207 
Strophanthin, 157 
Strophanthus, 157 

tincture of, 157 



Strychnine, 133 

sulphas, 133 
Strychnine, 131-133, 166 

preparations and doses of, 133 

sulphate, 133 

treatment of poisoning by, 132 
Sublimated sulphur, 190 
Suet, 266 

Sugar of lead, 235 
Sulphides, 248,249 
Sulphites, 248, 249 
Sulphonal, 100, 102 
Sulphur, flowers of, 190 

iodide, 166 

lotum, 190 

ointment, 190 

sublimatum, 190 

washed, 190 
Sulphurated antimony, 162 

lime, 249 

potassa, 190, 191, 249 
Sulphuric acid, 56, 57 

diluted, 58 
Sulphuris iodidum, 66 
Sulphurous acid, 248 
Sumach, 232, 233 

fluid extract, 233 
Suppositoria, 21 

glycerini, 267 
Suppositories, 20, 21 
Sweet spirit of nitre, 219 
Swertia chirata, 37 
Sydenham/s laudanum, 94 
Syrupi, 22 
Syrup of calcium lactophosphate, 72 

of ferrous iodide, 50 

of hypophosphites, 72 
with iron, 72 

of iron, quinine, and strychnine 
phosphate, 51 

simple, 22 
Syrups, 20, 22 
Syrupus acacia?, 263 

acidi citrici, 169 

alii, 225 

althaea?, 264 

amygdala?, 142 

aurantii, 187 
florurn, 187 

calcii lactophosphatis, 72 

calcis, 243 

ferri iodidi, 50 
quinine, et strychninee phos- 
phatum, 50 

hypophosphitum, 72 
cum ferro, 72 

ipecacuanha^, 179 

krameriae, 231 

lactucarii, 106 

picis liquids, 227 

primus virginianae, 41 

rhei, 191 
aromaticus, 191 

rosae, 232 

sarsaparillae compositus, 161, 208 



28(5 



INDEX. 



Syrupus senegas, 224 

sennas, 198 

tolutanus, 227 

zingiberis, 18") 
Systemic medicines, 35, 244 

Taba-cum, 144, 145 
Tamarind, 189 
Tamarindns, 189 
Tanacetin, 176 
Tanacetnm, 176 
Tannic acid, 229 
glyeerite of, 230 
ointment of, 230 
troches of, 230 
Tansy, 176 
Tar, 222, 227 

oil of, 227 

ointment of, 227 

water, 227 
Taraxacum, 210 

extract of, 210 

fluid extract of, 210 
Tartarated antimony, 161 
Tartar emetic, 161, 181,222 
Tartaric acid, 169 
Terebene, 222, 228 
Terebenum, 228 
Terebinthina, 214, 216 

Canadensis, 214 
Terpin, 222 

hydrate, 228 
Terpini hydras, 227 
Test for cinchona alkaloids, 43 
Tetronal, 103, 104 
Tetterwort, 197 
Thalline, 87 
Theine, 155 
Therapeutics, 17, 18 

empirical, 18 

rational, 18 
Thorough wort, 39 
Thymol, 186, 254, 255 
Tirictura aconiti, 163 

aloes, 192 
et myrrhas, 192 

arnicas radicis, 167 

asafcetida, 128 

belladonnas, 110 

benzoini, 226 
composita, 226 

byronise, 196 

calendulas, 76 

cannabis indicas, 105 

cantharidis, 217, 259 

cardamomi, 185 
composita, 185 

catechu composita, 231 

cimieifugas, 159 

cinchonas, 45 
composita, 45 

cinnamomi, 184 

colchici, 74 
croci, 269 
cubebas, 217 



Tinctura capsici, 183 

digitalis, 154 

ferri chloridi, 50 

gallas, 231 

gelsemii, 139 

guaiaci, 75 

humuli, 106 

hyoscyami, 112 

iodi, 66 

ipecacuanhas, 94 

kino, 231 

kramerias, 231 

lactucarii, 106 

lavendulas composita, 186 

lobelias, 142 

matico, 217 

moschi, 127 

nucis vomicas, 133 

opii, 94 
camphorata, 94 
deodorata, 94 

physostigmatis, 136 

quillajas, 224 

rhei, 191 
aromaticus, 192 
dulcis, 192 

sanguinarias, 225 

scillas, 208 

serpentarias, 41 

stramonii seminis, 111 

strophanthi, 157 

tolutani, 226 

valerinas, 127 
ammoniata, 127 

vanillas, 188 

veratri viridis, 165 

zingiberis, 185 
Tincturas, 22 
Tincture of aconite, 126 

of camphorated opium, 94 

of colchicum,74 

of deodorized opium, 94 

of elaterine, 198 

of ferric chloride, 50 

of guaiac, 75 

of iodine, 66 

of ipecac and opium, 94 

of opium, 94 
Tinctures, 20, 22 
Tobacco, 144, 145 

camphor, 144 
Tolu, balsam of, 227 

syrup of, 227 

tincture of, 227 
Tonics, mineral, 47, 59 

vegetable, 37-47 
subdivision of, 37 
Toxicology, 17 
Tragacanth, 264 
Tragacantha, 264 
Trional, 102 
Triticum, 212 

fluid extract of, 212 
Trituratio elaterine, 198 
Triturationes, 20 



INDEX. 



28 1 



Triturations, 19, 20 
Troches, 20 
Trochisci, 20 

acidi tannici, 230 

amnionii chloridi, 233 

catechu, 231 

cretae, 243 

cubebse, 217 

ferri, 49 

glycyrrhizse et opii, 94 

ipecacuanha?, 179 

krameria?, 231 

mentha? piperita?, 186 

morphina? et ipecacuanha?, 94 

potassii chloratis, 20G 

santonini, 200 

sodii bicarbonatis, 242 

zingiberis, 185 
Tully's powder, 94 
Turpentine, 214, 216, 222, 228 

Bordeaux, 214 

Canada, 214 

Chian, 214 

Venice, 214 
Turpeth mineral, 63, 181 
Tutty, 238 

Ulmus, 264 
Unguenta, 21 
Unguents, 21 
Unguentum, 266 
acidi carbolici, 251 

tannici, 230 
aqua? rosa?, 232 
belladonna?, 110 
diachylon, 235 
gallaV231 
hydrargyri, 62 
ammoniati, 63 
nitratis, 63 
oxidi flavi, 62 
rubri, 62 
iodi, 66 
iodoformi, 248 
picis liquida?, 227 
plumbi carbonatis, 236 

iodidi, 235 
potassii iodidi, 66 
straraonii, 111 
sulphurus, 190 
veratrina?, 166 
zinci oxidi, 238 
Unslaked lime, 243 
Urethan, 104 
Uva ursi, 212 

Valerian, 127 

ammoniated tincture of, 127 

fluid extract of, 127 

preparations and doses of, 127 

tincture of, 127 
Valeriana, 127 
Vanilla, 188 
Vanillin, 188 
Vegetable cathartic pills, 198 



Vegetable tonics, 37-47 
Veratrine, 165, 166 

ointment of, 166 

oleate of, 166 

uses and preparations of, 166 
Veratroidine, 164 
Veratrum viride, 164, 165, 218 
fluid extract of, 165 
preparations and doses of, 165 
tincture of, 165 
Viburnum, fluid extract of, 175 

pruni folium, 175 
Vienna paste, 260 
Vina, 22 

Vinegar of opium, 94 
Vinegars, 20, 22 
Vinum album, 148 

antimonii, 161 

colchici radicis, 74 

ergota?, 173 

ferri amarum, 51 
citratis, 51 

ipecacuanha?, 179 

opii, 94 

rubrum, 148, 149 

seminis, 74 
Viola tricolor, 189 
Virginia snakeroot, 39 
Veratrina, 165, 166 

uses and preparations of, 166 
Volatile oil of betula, 84 

Wahoo, 193 
Washed sulphur, 190 
Washes, 23 
Waters, 20, 21 
Wax, white, 266 

yellow, 266 
Weight, apothecaries', 23 

relation of, to metrical system, 25 
Weights and measures, 23-26. 
decimal, 24 
metrical, 24 
Whiskey, 148 
White arsenic, 69 

lead, 232 

oak, 232 

precipitate 63 

vitriol, 238 

wine, 148 
Wild cherry, 39 
Wine measure, 24 

relation of, to metrical system, 28 

of antimony, 161 

of colchicum root, 74 
seed, 74 

of iron citrate, 51 

of opium, 94 
Wines, 20, 22 
Wintergreen, 186 
Wisters' cough drops, 94 
Witch hazel, 232 
Woorali, 144 
Woorara, 144 
Wormwood, 40 



288 



INDEX. 



Yellow bark, 42 

mercurial subsulphate, 61, 181 

mercuric oxide, 62 

root, 46 
Young's rule for dose in children, 31 

Zea, 214 

fluid extract of, 214 
Zinc acetate, 238 

bromide, 99, 239 

carbonate, precipitated, 238 

chloride, 238, 261 

iodide, 239 

ointment, 238 



Zinc oxide, 238 
phosphide, 55, 239 
sulphate, 181, 238 
valerianate, 239 

Zinci acetas, 238 
bromidum, 99, 239 
carbonas prsecipitatus, 
chloridum, 238, 2C1 
iodidum, 239 
phosphidum, 55, 239 
sulphas, 181, 238 
valerianas, 239 

Zincum, 238, 239 

Zingiber, 184, 185 



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upon a comprehensive knowledge of the subject assigned to him; another, and 
perhaps the most important, advantage is that the student gains the point of view 
of a number of teachers. In a measure he reaps the same benefit as would be 
obtained by following courses of instruction under different teachers. The 
different standpoints assumed, and the differences in emphasis laid upon the 
various lines of procedure, chemical, physical, and anatomical, should give the 
student a better insight into the methods of the science as it exists to-day. The 
work will also be found useful to many medical practitioners who may wish to 
keep in touch with the development of modern physiology. 

The main divisions of the subject-matter are as follows : General Physiology 
of Muscle and Nerve — Secretion — Chemistry of Digestion and Nutrition — 
Movements of the Alimentary Canal, Bladder, and Ureter — Blood and Lymph 
— Circulation — Respiration — Animal Heat — Central Nervous System — Special 
Senses — Special Muscular Mechanisms — Reproduction — Chemistry of the 
Animal Body. 

CONTRIBUTORS : 



HENRY P. BOWDITCH, M. D., 

Professor of Physiology, Harvard Medi- 
cal School. 

JOHN G. CURTIS, M. D., 

Professor of Physiology, Columbia Uni- 
versity, N. Y. (College of Physicians 
and Surgeons). 

HENRY H. DONALDSON, Ph.D., 

Head-Professor of Neurology, Univer- 
sity of Chicago. 
W. H. HOWELL, Ph. D., M. D., 

Professor of Physiology, Johns Hopkins 
University. 

FREDERIC S. LEE, Ph. D., 

Adjunct Professor of Physiology, Colum- 
bia University, N. Y. (College of 
Physicians and Surgeons). 



WARREN P. LOMBARD, M. p., 

Professor of Physiology, University of 
Michigan. 

GRAHAM LUSK, Ph.D., 

Professor of Physiology, Yale MedicaJ 
School. 

W. T. PORTER, M.D., 

Assistant Professor of Physiology, Har- 
vard Medical School. 

EDWARD T. REICHERT, M.D., 

Professor of Physiology, University of 
Pennsylvania. 

HENRY SEW ALL, Ph.D., M. D., 

Professorof Physiology, Medical Deparfr 
ment, University of Denver. 



W. B. SAUNDERS' 



For Sale by Subscription. 



AN AMERICAN TEXT-BOOK OF APPLIED THERAPEU- 
TICS. For the Use of Practitioners and Students. Edited by 
James C. Wilson, M. D., Professor of the Practice of Medicine and of 
Clinical Medicine in the Jefferson Medical College. One handsome octavo 
volume of 1326 pages. Illustrated. Prices: Cloth, $7.00 net; Sheep or 
Half-Morocco, $8.00 net. 



The arrangement of this volume has been based, so far as possible, upon 
modern pathologic doctrines, beginning with the intoxications, and following 
with infections, diseases due to internal parasites, diseases of undetermined 
origin, and finally the disorders of the several bodily systems— digestive, re- 
spiratory, circulatory, renal, nervous, and cutaneous. It was thought proper to 
include also a consideration of the disorders of pregnancy. 

The list of contributors comprises the names of" many who have acquired dis- 
tinction as practitioners and teachers of practice, of clinical medicine, and of 
the specialties. 

CONTRIBUTORS : 



Dr. I. E. Atkinson, Baltimore, Md. 
Sanger Brown, Chicago, 111. 
John B. Chapin, Philadelphia, Pa. 
William C. Dabney, Charlottesville, Va. 
John Chalmers DaCosta, Philada., Pa. 
I. N. Danforth, Chicago, 111. 
John L. Dawson, Jr., Charleston, S. C. 
F. X. Dercum, Philadelphia, Pa. 
George Dock, Ann Arbor, Mich. 
Robert T. Edes, Jamaica Plain, Mass. 
Augustus A. Eshner, Philadelphia, Pa. 
J. T. Eskridge, Denver, Col. 
F. Forchheimer, Cincinnati, O. 
Carl Frese, Philadelphia, Pa. 
Edwin E. Graham, Philadelphia, Pa. 
John Guiteras, Philadelphia, Pa. 
Frederick P. Henry, Philadelphia, Pa. 
Guy Hinsdale, Philadelphia, Pa. 
Orville Horwitz, Philadelphia, Pa. 
W. W. Johnston, Washington, D. C. 
Ernest Laplace, Philadelphia, Pa. 
A. Laveran, Paris, France. 



Dr. James Hendrie Lloyd, Philadelphia, Pa. 
John Noland Mackenzie, Baltimore, Md. 
J. W. McLaughlin, Austin, Texas. 
A. Lawrence Mason, Boston, Mass. 
Charles K. Mills, Philadelphia, Pa. 
John K. Mitchell, Philadelphia, Pa. 
W. P. Northrup, New York City. 
William Osier, Baltimore, Md. 
Frederick A. Packard, Philadelphia, Pa. 
Theophilus Parvin, Philadelphia, Pa. 
Beaven Rake, London, England. 
E. O. Shakespeare, Philadelphia, Pa. 
Wharton Sinkler, Philadelphia, Pa. 
Louis Starr, Philadelphia, Pa. 
Henry W. Stelwagon, Philadelphia, Pa. 
James Stewart, Montreal, Canada. 
Charles G. Stockton, Buffalo, N. Y. 
James Tyson, Philadelphia, Pa. 
Victor C. Vaughan, Ann Arbor, Mich. 
James T. Whittaker, Cincinnati, O. 
J. C. Wilson, Philadelphia, Pa. 



The ai-ticles, with two exceptions, are the contributions of American writers. 
Written from the standpoint of the practitioner, the aim of the work is to facili- 
tate the application of knowledge to the prevention, the cure, and the allevia- 
tion of disease. The endeavor throughout has been to conform to the title of 
the book — Applied Therapeutics — to indicate the course of treatment to be 
pursued at the bedside, rather than to name a list of drugs that have been used 
at one time or another. 

While the scientific superiority and the practical desirability of the metric 
system of weights and measures is admitted, it has not been deemed best to 
discard entirely the older system of figures, so that both sets have been given 
where occasion demanded. 



CATALOGUE OF MEDICAL WORKS. 



For Sale by Subscription. 



AN AMERICAN TEXT-BOOK OF OBSTETRICS. Edited by 
Richard C. Norris, M. D. ; Art Editor, Robert L. Dickinson, M. D. 
One handsome octavo volume of over iooo pages, with nearly 900 colored 
and half-tone illustrations. Prices : Cloth, $7.00 ; Sheep or Half-Morocco, 
$8.00. 

The advent of each successive volume of the series of the American Text- 
Books has been signalized by the most flattering comment from both the Press 
and the Profession. The high consideration received by these text-books, and 
their attainment to an authoritative position in current medical literature, have 
been matters of deep international interest, which finds its fullest expression in 
the demand for these publications from all parts of the civilized world. 

In the preparation of the "American Text-Book of Obstetrics" the 
editor has called to his aid proficient collaborators whose professional prominence 
entitles them to recognition, and whose disquisitions exemplify Practical 
Obstetrics. While these writers were each assigned special themes for dis- 
cussion, the correlation of the subject-matter is, nevertheless, such as ensures 
logical connection in treatment, the deductions of which thoroughly represent 
the latest advances in the science, and which elucidate the best modern methods 
of procedure. 

The more conspicuous feature of the treatise is its wealth of illustrative 
matter. The production of the illustrations had been in progress for several 
years, under the personal supervision of Robert L. Dickinson, M. D., to whose 
artistic judgment and professional experience is due the most sumptuously 
illustrated work of the period. By means of the photographic art, combined 
with the skill of the artist and draughtsman, conventional illustration is super- 
seded by rational methods of delineation. 

Furthermore, the volume is a revelation as to the possibilities that may be 
reached in mechanical execution, through the unsparing hand of its publisher. 



CONTRIBUTORS 



Dr. James C. Cameron. 
Edward P. Davis. 
Robert L. Dickinson. 
Charles Warrington Earle. 
James H. Etheridge. 
Henry J. Garrigues. 
Barton Cooke Hirst. 
Charles Jewett. 



Howard A. Kelly. 
Richard C. Norris. 
Chauncey D. Palmer. 
Theophilus Parvin. 
George A. Piersol. 
Edward Reynolds. 
Henry Schwarz. 



"At first glance we are overwhelmed by the magnitude of this work in several respects, 
viz. : First, by the size of the volume, then by the array of eminent teachers in this depart- 
ment who have taken part in its production, then by the profuseness and character of the 
illustrations, and last, but not least, the conciseness and clearness with which the text is ren- 
dered. This is an entirely new composition, embodying the highest knowledge of the art as 
it stands to-day by authors who occupy the front rank in their specialty, and there are many 
of them. We cannot turn over these pages without being struck by the superb illustrations 
which adorn so many of them. We are confident that this most practical work will find 
instant appreciation by practitioners as well as students." — New York Medical Times. 

Permit me to say that your American Text-Book of Obstetrics is the most magnificent 
medical work that 1 have ever seen. I congratulate you and thank you for this superb work, 
which alone is sufficient to place you first in the ranks of medical publishers. 

With profound respect I am sincerely yours, Alex. J. C. Skene. 



W. B. SAUNDEKS* 



For Sale by Subscription. 



AN AMERICAN TEXT-BOOK ON THE THEORY AND 
PRACTICE OF MEDICINE. By American Teachers. Edited 
by William Pepper, M. D., LL.D., Provost and Professor of the Theory 
and Practice of Medicine and of Clinical Medicine in the University of 
Pennsylvania. Complete in two handsome royal-octavo volumes of about 
iooo pages each, with illustrations to elucidate the text wherever necessary. 
Price per Volume : Cloth, #5.00 net; Sheep or Half-Morocco, $6.00 net. 



VOLUME I. CONTAINS: 



Hygiene. — Fevers (Ephemeral, Simple Con- 
tinued, Typhus, Typhoid, Epidemic Cerebro- 
spinal Meningitis, and Relapsing). — Scarla- 
tina, Measles, Rotheln, Variola, Varioloid, 
Vjccinia, Varicella, Mumps, Whooping-cough, 
Anthrax, Hydrophobia, Trichinosis, Actino- 



mycosis, Glanders, and Tetanus.— Tubercu- 
losis, Scrofula, Syphilis, Diphtheria, Erysipe- 
las, Malaria, Cholera, and Yellow Fever. — 
Nervous, Muscular, and Mental Diseases etc. 



Urine (Chemistry and Microscopy). — Kid- 
ney and Lungs. — Air-passages (Larynx and 
Bronchi) and Pleura. — Pharynx, Oesophagus, 
Stomach and Intestines (including Intestinal 
Parasites), Heart, Aorta, Arteries and Veins. 



VOLUME II. CONTAINS: 

Peritoneum, Liver, and Pancreas. — Diathet- 



ic Diseases (Rheumatism, Rheumatoid Ar- 
thritis, Gout, Lithaemia, and Diabetes.) — 
Blood and Spleen. — Inflammation, Embolism, 
Thrombosis, FeVer, and Bacteriology. 



The articles are not written as though addressed to students in lectures, but 
are exhaustive descriptions of diseases, with the newest facts as regards Causa- 
tion, Symptomatology, Diagnosis, Prognosis, and Treatment, including a large 
number of approved formulae. The recent advances made in the study 
of the bacterial origin of various diseases are fully described, as well as the 
bearing of the knowledge so gained upon prevention and cure. The subjects 
of Bacteriology as a whole and of Immunity are fully considered in a separate 
section. 

Methods of diagnosis are given the most minute and careful attention, thus 
enabling the reader to learn the very latest methods of investigation without 
consulting works specially devoted to the subject. 



CONTRIBUTORS : 



Dr. J. S. Billings, Philadelphia. 
Francis Delafield, New York. 
Reginald H. Fitz, Boston. 
James W. Holland, Philadelphia. 
Henry M. Lyman, Chicago. 
William Osier, Baltimore. 



Dr. William Pepper, Philadelphia. 
W. Gilman Thompson, New York. 
W. H. Welch, Baltimore. 
James T. Whittaker, Cincinnati. 
James C. Wilson, Philadelphia. 
Horatio C. Wood, Philadelphia. 



" We reviewed the first volume of this work, and said : ' It is undoubtedly one of the best 
text-books on the practice of medicine which we possess.' A consideration of the second 
and last volume leads us to modify that verdict and to say that the completed work is, in our 
opinion, the best of its kind it has ever been our fortune to see. It is complete, thorough, 
accurate, and clear. It is well written, well arranged, well printed, well illustrated, and well 
bound. It is a model of what the modern text-book should be." — New York Medical Journal. 

"A library upon modern medical art. The work must promote the wider diffusion of 
sound knowledge." — American Lancet. 

" A trusty counsellor for the practitioner or senior student, on which he may implicitly 
rely." — Edinburgh Medical Journal. 



CATALOGUE OF MEDICAL WORKS. 



For Sale by Subscription. 



AN AMERICAN TEXT-BOOK OF SURGERY. Edited by Wil- 
liam W. Keen, M.D., LL.D., and J. William White, M. D., Ph. D. 
Forming one handsome royal-octavo volume of 1250 pages (10x7 inches), 
with 500 wood-cuts in text, and 37 colored and half-tone plates, many of 
them engraved from original photographs and drawings furnished by the 
authors. Prices : Cloth, $7.00 net; Sheep or Half-Morocco, $8.00 net. 

SECOND EDITION, REVISED AND ENLARGED, 

With a Section devoted to " The Use of the Rbntgen Rays in Surgery." 

The want of a text-book which could be used by the practitioner and at the 
same time be recommended to the medical student has been deeply felt, espe- 
cially by teachers of surgery; hence, when it was suggested to a num6er of 
these that it would be well to unite in preparing a text-book of this description, 
great unanimity of opinion was found to exist, and the gentlemen below named 
gladly consented to join in its production. While there is no distinctive Amer- 
ican Surgery, yet America has contributed very largely to the progress of modern 
surgery, and among the foremost of those who have aided in developing this art 
and science will be found the authors of the present volume. All of them are 
teachers of surgery in leading medical schools and hospitals in the United States 
and Canada. 

Especial prominence has been given to Surgical Bacteriology, a feature which 
is believed to be unique in a surgical text-book in the English language. Asep- 
sis and Antisepsis have received particular attention. The text is brought well 
up to date in such important branches as cerebral, spinal, intestinal, and pelvic 
surgery, the most important and newest operations in these departments being 
described and illustrated. 

The text of the entire book has been submitted to all the authors for their 
mutual criticism and revision — an idea in book-making that is entirely new and 
original. The book as a whole, therefore, expresses on all the important sur- 
gical topics of the day the consensus of opinion of the eminent surgeons who 
have joined in its preparation. 

One of the most attractive features of the book is its illustrations. Very 
many of them are original and faithful reproductions of photographs taken 
directly from patients or from specimens. 



CONTRIBUTORS: 



Dr. Charles H. Burnett, Philadelphia. 
Phineas S. Conner, Cincinnati. 
Frederic S. Dennis, New York. 
William W. Keen, Philadelphia. 
Charles B. Nancrede, Ann Arbor, Mich. 
Roswell Park, Buffalo, N. Y. 
Lewis S. Pilcher, New York. 



Dr. Nicholas Senn, Chicago. 

Francis J. Shepherd, Montreal, Canada. 

Lewis A. Stimson, New York. 

William Thomson, Philadelphia. 

J. Collins Warren, Boston. 

J. William White, Philadelphia. 



, . . t ^ ,s text -book is a fair reflex of the present position of American surgery, we must 
admit it is of a very high order of merit, and that English surgeons will have to look very 
carefully to their laurels if they are to preserve a position in the van of surgical practice."— 
London Lancet. 



It', fi. $AUNDEk$ s 



For Sale by Subscription, 



AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL 
AND SURGICAL, for the use of Students and Practitioners. 
Edited by J. M. Baldy, M. D. Forming a handsome royal-octavo volume, 
with 341 illustrations in text and 38 colored and half-tone plates. Prices : 
Cloth, $6.00 net; Sheep or Half-Morocco, $7.00 net. 

SECOND EDITION, THOROUGHLY REVISED. 

In this volume all anatomical descriptions, excepting those essential to a cleat 
understanding of the text, have been omitted, the illustrations being largely de- 
pended upon to elucidate the anatomy of the parts. This work, which is 
thoroughly practical in its teachings, is intended, as its title implies, to be a 
working text-book for physicians and students. A clear line of treatment has 
been laid down in every case, and although no attempt has been made to dis- 
cuss mooted points, still the most important of these have been noted and ex- 
plained. The operations recommended are fully illustrated, so that the reader, 
having a picture of the procedure described in the text under his eye, cannot fail 
to grasp the idea. All extraneous matter and discussions have been carefully 
excluded, the attempt being made to allow no unnecessary details to cumber 
the text. The subject-matter is brought up to date at every point, and the 
work is as nearly as possible the combined opinions of the ten specialists who 
figure as the authors. 



CONTRIBUTORS : 



Dr. Henry T. Byford. 
John M. Baldy. 
Edwin Cragin. 
»'. H. Etheridge. 
William Goodell. 



Dr. Howard A. Kelly. 
Florian Krug. 
E. E. Montgomery. 
William R. Pryor. 
George M. Tuttle. 



"The most notable contribution to gynecological literature since 1887, .... and the most 
complete exponent of gynecology which we have. No subject seems to have been neglected, 
.... and the gynecologist and surgeon, and the general practitioner who has any desire 
to practise diseases of women, will find it of practical value. In the matter of illustrations 
and plates the book surpasses anything we have seen." — Boston Medical and Surgical 
Journal. 

"A valuable addition to the literature of Gynecology. The writers are progressive, 
aggressive, and earnest in their convictions." — Medical News, Philadelphia. 

" A thoroughly modern text-book, and gives reliable and well-tempered advice and in- 
struction." — Edinburgh Medical Journal. 

" The harmony of its conclusions and the homogeneity of its style give it an individuality 
which suggests a single rather than a multiple authorship." — Annals of Surgery. 

" It must command attention and respect as a worthy representation of our advanced 
clinical teaching." — American Journal of Medical Sciences. 



CATALOGUE OF MEDICAL WORKS. 



For Sale by Subscription. 

AN AMERICAN TEXT-BOOK OF THE DISEASES OF CHIL- 
DREN. By American Teachers. Edited by Louis Starr, M. D., 
assisted by Thompson S. Westcott, M. D. In one handsome royal-8vo 
volume of 1250 pages, profusely illustrated with wood-cuts, half-tone and 
colored plates. Net Prices : Cloth, $7.00; Sheep or Half-Morocco, $8.00. 

SECOND EDITION, REVISED AND ENLARGED. 

The plan of this work embraces a series of original articles written by some 
sixty well-known podiatrists, representing collectively the teachings of the most 
prominent medical schools and colleges of America. The work is intended to 
be a PRACTICAL book, suitable for constant and handy reference by the practi- 
tioner and the advanced student. 

Especial attention has been given to the latest accepted teachings upon the 
etiology, symptoms, pathology, diagnosis, and treatment of the disorders of chil- 
dren, with the introduction of many special formulae and therapeutic procedures. 

Special chapters embrace at unusual length the Diseases of the Eye, Ear, 
Nose and Throat, and the Skin ; while the introductory chapters cover fully the 
important subjects of Diet, Hygiene, Exercise, Bathing, and the Chemistry of 
Food. Tracheotomy, Intubation, Circumcision, and such minor surgical pro- 
cedures coming within the province of the medical practitioner are carefully 
considered. 

CONTRIBUTORS : 



Dr. S. S. Adams, Washington. 

John Ashhurst, Jr., Philadelphia. 
A. D. Blackader, Montreal, Canada. 
David Bovaird, New York. 
Dillon Brown, New York. 
Edward M. Buckingham, Boston. 
Charles W. Burr, Philadelphia. 
W. E. Casselberry, Chicago. 
Henry Dwight Chapin, New York. 
W. S. Christopher, Chicago. 
Archibald Church, Chicago. 
Floyd M. Crandall, New York. 
Andrew F. Currier, New York. 
Roland G. Curtin, Philadelphia 
J. M. DaCosra, Philadelphia. 
I. N. Danforth, Chicago. 
Edward P. Davis, Philadelphia. 
John B. Deaver, Philadelphia. 
G. E. de Schwcinitz, Philadelphia. 
John Doming, New York. 
Charles Warrington Earle, Chicago. 
Wm. A. Edwards, San Diego, Cal. 
F. Forchheimer, Cincinnati. 
J. Henry Fruitnight, New York. 
J. P. Crozer Griffith, Philadelphia. 
W. A. Hardaway. St. Louis. 
M. P Hatfield, Chicago. 
Barton Cooke Hirst, Philadelphia. 
H. Illovvay, Cincinnati. 
Henry Jackson, Boston. 
Charles G. Jennings, Detroit, 
Henry Koplik, New York. 



Dr. Thomas S. Latimer, Baltimore. 
Albert R. Leeds, Hoboken, N. J. 
J. Hendrie Lloyd, Philadelphia. 
George Roe Lockwood, New York. 
Henry M. Lyman, Chicago. 
Francis T. Miles, Baltimore. 
Charles K Mills, Philadelphia. 
James E Moore, Minneapolis. 
F. Gordon Morrill, Boston. 
John H. Musser, Philadelphia. 
Thomas R. Neilson, Philadelphia. 
W. P. Northrup, New York. 
William Osier, Baltimore. 
Frederick A. Packard, Philadelphia. 
William Pepper, Philadelphia. 
Frederick Peterson, New York. 
W. T. Plant, Syracuse, New York. 
William M. Powell, Atlantic City. 
B. Alexander Randall, Philadelphia. 
Edward O. Shakespeare, Philadelphia 
F. C. Shattuck, Boston. 
J. Lewis Smith, New York. 
Louis Starr, Philadelphia. 
M. Allen Starr, New York. 
Charles W. Townsend, Boston. 
James Tyson, Philadelphia. 
W. S. Thayer, Baltimore. 
Victor C. Vaughan, Ann Arbor, Mich 
Thompson S. Westcott, Philadelphia. 
Henry R. Wharton, Philadelphia. 
J. William White, Philadelphia. 
J. C. Wilson, Philadelphia. 



IO IV. B. SAUNDERS 



A NEW PRONOUNCING DICTIONARY OF MEDICINE, with 
Phonetic Pronunciation, Accentuation, Etymology, etc. By John 
M. Keating, M. D., LL.D., Fellow of the College of Physicians of Phila- 
delphia; Vice-President of the American Paediatric Society; Ex-President 
of the Association of Life Insurance Medical Directors ; Editor " Cyclo- 
paedia of the Diseases of Children," etc. ; and Henry Hamilton, author 
of " A New Translation of Virgil's ^Eneid into English Rhyme ;" co- 
author of "Saunders' Medical Lexicon," etc.; with the Collaboration of 
J. Chalmers DaCosta, M. D., and Frederick A. Packard, M. D. 
With an Appendix containing important Tables of Bacilli, Micrococci, 
Leucomaines, Ptomaines, Drugs and Materials used in Antiseptic Sur- 
gery, Poisons and their Antidotes, Weights and Measures, Thermometric 
Scales, New Official and Unofficial Drugs, etc. One very attractive volume 
of over 800 pages. Second Revised Edition. Prices: Cloth, $5.00 net ; 
Sheep or Half- Morocco, #6.00 net; with Denison's Patent Ready- Refer- 
ence Index; without patent index, Cloth, $4.00 net; Sheep or Half- 
Morocco, $5.00 net. 

PROFESSIONAL OPINIONS. 

" I am much pleased with Keating's Dictionary, and shall take pleasure in recommending 
it to my classes." 

Henry M. Lyman, M. D., 
Professor of Principles and Practice of Medicine, Rush Medical College, Chicago, III. 

" I am convinced that it will be a very valuable adjunct to my study-table, convenient in 
size and sufficiently full for ordinary use." 

C. A. LlNDSLEY, M. D., 

Professor of Theory and Practice of Medicine, Medical Dept. Yale University ; 

Secretary Connecticut State Board of Health, New Haven, Conn, 



AUTOBIOGRAPHY OF SAMUEL D. GROSS, M. D., Emeritus Pro- 
fessor of Surgery in the Jefferson Medical College of Philadelphia, with 
Reminiscences of His Times and Contemporaries. Edited by his sons, 
Samuel W. Gross, M. D., LL.D., late Professor of Principles of Surgery 
and of Clinical Surgery in the Jefferson Medical College, and A. Haller 
Gross, A. M., of the Philadelphia Bar. Preceded by a Memoir of Dr. 
Gross, by the late Austin Flint, M. D., LL.D. In two handsome volumes, 
each containing over 400 pages, demy 8vo, extra cloth, gilt tops, with fine 
Frontispiece engraved on steel. Price per Volume, $2.50 net. 
This autobiography, which was continued by the late eminent surgeon until 
within three months of his death, contains a full and accurate history of his 
early struggles, trials, and subsequent successes, told in a singularly interesting 
and charming manner, and embraces short and graphic pen-portraits of many 
of the most distinguished men — surgeons, physicians, divines, lawyers, states- 
men, scientists, etc. — with whom he was brought in contact in America and in 
Europe ; the whole forming a retrospect of more than three-quarters of a century. 



CATALOGUE OF MEDICAL WORKS. II 

SURGICAL PATHOLOGY AND THERAPEUTICS. By John 
Collins Warren, M. D., LL.D., Professor of Surgery, Medical Depart- 
ment Harvard University; Surgeon to the Massachusetts General Hospital, 
etc. A handsome octavo volume of 832 pages, with 136 relief and litho- 
graphic illustrations, 33 of which are printed in colors, and all of which 
were drawn by William J. Kaula from original specimens. Prices : Cloth, 
$6.00 net; Half-Morocco, $7.00 net. 

" The volume is for the bedside, the amphitheatre, and the ward. It deals 
with things not as we see them through the microscope alone, but as the prac- 
titioner sees their effect in his patients ; not only as they appear in and affect 
culture-media, but also as they influence the human body ; and, following up 
the demonstrations of the nature of diseases, the author points out their logical 
treatment." {New Yo?'k Medical Journal). " It is the handsomest specimen 
of book-making * * * that has ever been issued from the American medical 
press" (American Journal of the Medical Sciences, Philadelphia). 

"Without Exception, the Illustrations are the Best ever Seen in a 
Work of this Kind. 

"A most striking and very excellent feature of this book is its illustrations. Without ex- 
ception, from the point of accuracy and artistic merit, they are the best ever seen in a work 
of this kind. * * * Many of those representing microscopic pictures are so perfect in their 
coloring and detail as almost to give the beholder the impression that he is looking down the 
barrel of a microscope at a well-mounted section." — Annals of Surgery , Philadelphia. 

PATHOLOGY AND SURGICAL TREATMENT OF TUMORS. 

By N. Senn, M. D., Ph. D., LL. D., Professor of Practice of Surgery and 
of Clinical Surgery, Rush Medical College ; Professor of Surgery, Chicago 
Polyclinic ; Attending Surgeon to Presbyterian Hospital ; Surgeon-in-Chief, 
St. Joseph's Hospital, Chicago. One volume of 710 pages, with 515 
engravings, including full-page colored plates. Prices: Cloth, $6.00 net; 
Half-Morocco, $7.00 net. 

Books specially devoted to this subject are few, and in our text-books and 
systems of surgery this part of surgical pathology is usually condensed to a de- 
gree incompatible with its scientific and clinical importance. The author spent 
many years in collecting the material for this work, and has taken great pains 
to present it in a manner that should prove useful as a text-book for the student, 
a work of reference for the busy practitioner, and a reliable, safe guide for the 
surgeon. The more difficult operations are fully described and illustrated. More 
than one hundred of the illustrations are original, while the remainder were 
selected from books and medical journals not readily accessible. 

" The most exhaustive of any recent book in English on this subject. It is well illus- 
trated, and will doubtless remain as the principal monograph on the subject in our language 
for some years. The book is handsomely illustrated and printed, .... and the author has 
given a notable and lasting contribution to surgery." — Journal of American Medical Asso- 
ciation, Chicago. 



12 tV. B. SAUNDERS 

MEDICAL DIAGNOSIS. By Dr. Oswald Vierordt, Professor of 
Medicine at the University of Heidelberg. Translated, with additions, 
from the Fifth Enlarged German Edition, with the author's permission, by 
Francis H. Stuart, A. M., M. D. In one handsome royal-octavo volume 
of 600 pages. 194 fine wood-cuts in the text, many of them in colors. 
Prices: Cloth, $4.00 net; Sheep or Half-Morocco, $5.00 net. 

FOURTH AMERICAN EDITION, FROM THE FIFTH REVISED AND 
ENLARGED GERMAN EDITION. 

In this work, as in no other hitherto published, are given full and accurate 
explanations of the phenomena observed at the bedside. It is distinctly a clin- 
ical work by a master teacher, characterized by thoroughness, fulness, and accu- 
racy. It is a mine of information upon the points that are so often passed over 
without explanation. Especial attention has been given to the germ-theory as a 
factor in the origin of disease. 

This valuable work is now published in German, English, Russian, and 
Italian. The issue of a third American edition within two years indicates the 
favor with which it has been received by the profession. 

THE PICTORIAL ATLAS OF SKIN DISEASES AND SYPHI- 
LITIC AFFECTIONS. (American Edition.) Translation from 
the French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Phy- 
sician to, and Physician to the department for Diseases of the Skin at, the 
Middlesex Hospital, London. Photo-lithochromes from the famous models 
of dermatological and syphilitic cases in the Museum of the Saint-Louis 
Hospital, Paris, with explanatory wood-cuts and letter-press. In 12 Parts, 
at $3.00 per Part. Parts I to 8 now ready. 

" The plates are beautifully executed." — Jonathan Hutchinson, M. D. (London 
Hospital). 

" The plates in this Atlas are remarkably accurate and artistic reproductions of typical 
examples of skin disease. The work will be of great value to the practitioner and student." 
— William Anderson, M. D. (St. Thomas Hospital). 

" If the succeeding parts of this Atlas are to be similar to Part 1, now before us, we have 
no hesitation in cordially recommending it to the favorable notice of our readers as one of 
the finest dermatological aliases with which we are acquainted." — Glasgow Medical Journal, 
Aug., 1895. 

" Of all the atlases of skin diseases which have been published in recent years, the present 
one promises to be of greatest interest and value, especially from the standpoint of the 
general practitioner." — American Medico-Surgical Bulletin, Feb. 22, 1896. 

" The introduction of explanatory wood-cuts in the text is a novel and most important 
feature which greatly furthers the easier understanding of the excellent plates, than which 
nothing, we venture to say, has been seen better in point of correctness, beauty, and general 
merit." — New York Medical Journal, Feb. 15, 1896. 

" An interesting feature of the Atlas is the descriptive text, which is written for each picture 
by the physician who treated the case or at whose instigation the models have been made. 
We predict for this truly beautiful work a large circulation in all parts of the medical world 
where the names St. Louis and Baretta have preceded it." — Medical Record, N. Y., Feb. 1, 
1896. 



CATALOGUE OF MEDICAL WORKS. 



PRACTICAL POINTS IN NURSING. For Nurses in Private 
Practice. By Emily A. M. Stoney, Graduate of the Training-School 
for Nurses, Lawrence, Mass. ; Superintendent of the Training-School for 
Nurses, Carney Hospital, South Boston, Mass. 456 pages, handsomely 
illustrated with 73 engravings in the text, and 9 colored and half-tone 
plates. Cloth. Price, #1.75 net. 

SECOND EDITION, THOROUGHLY REVISED. 

In this volume the author explains, in popular language and in the shortest 
possible form, the entire range of private nursing as distinguished from hospital 
nursing, and the nurse is instructed how best to meet the various emergencies of 
medical and surgical cases when distant from medical or surgical aid or when 
thrown on her own resources. 

An especially valuable feature of the work will be found in the directions to 
the nurse how to improvise everything ordinarily needed in the sick-room, where 
the embarrassment of the nurse, owing to the want of proper appliances, is fre- 
quently extreme. 

The work has been logically divided into the following sections : 

I. The Nurse : her responsibilities, qualifications, equipment, etc. 
II. The Sick-Room : its selection, preparation, and management. 

III. The Patient : duties of the nurse in medical, surgical, obstetric, and gyne- 

cologic cases. 

IV. Nursing in Accidents and Emergencies. 
V. Nursing in Special Medical Cases. 

VI. Nursing of the New-born and Sick Children. 
VII. Physiology and Descriptive Anatomy. 

The Appendix contains much information in compact form that will be found 
of great value to the nurse, including Rules for Feeding the Sick; Recipes for 
Invalid Foods and Beverages; Tables of Weights and Measures; Table for 
Computing the Date of Labor; List of Abbreviations ; Dose-List; and a full 
and complete Glossary of Medical Terms and Nursing Treatment. 

" This is a well-written, eminently practical volume, which covers the entire range of 
private nursing as distinguished from hospital nursing, and instructs the nurse how best to 
meet the various emergencies which may arise and how to prepare everything ordinarily 
needed in the illness of her patient." — American Journal of Obstetrics and Diseases of 
Women and Children, Aug., 1896. 

A TEXT-BOOK OF BACTERIOLOGY, including the Etiology and 
Prevention of Infective Diseases and an account of Yeasts and Moulds, 
Hsematozoa, and Psorosperms. By Edgar M. Crookshank, M. B., Pro- 
fessor of Comparative Pathology and Bacteriology, King's College, London. 
A handsome octavo volume of 700 pages, with 273 engravings in the text, 
and 22 original and colored plates. Price, $6.50 net. 

This book, though nominally a Fourth Edition of Professor Crookshank's 
" Manual of Bacteriology," is practically a new work, the old one having 
been reconstructed, greatly enlarged, revised throughout, and largely rewritten, 
forming a text-book for the Bacteriological Laboratory, for Medical Ofhcers of 
Health, and for Veterinary Inspectors. 



14 W. B. SAUNDERS 1 



A TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC- 
TICAL. For the Use of Students. By Arthur Clarkson, M. B., 
CM., Edin., formerly Demonstrator of Physiology in the Owen's College, 
Manchester; late Demonstrator of Physiology in the Yorkshire College, 
Leeds. Large 8vo, 554 pages, with 22 engravings in the text, and 174 
beautifully colored original illustrations. Price, strongly bound in Cloth, 
$6.00 net. 

The purpose of the writer in this work has been to furnish the student of His- 
tology, in one volume, with both the descriptive and the practical part of the 
science. The first two chapters are devoted to the consideration of the general 
methods of Histology ; subsequently, in each chapter, the structure of the tissue 
or organ is first systematically described, the student is then taken tutorially over 
the specimens illustrating it, and, finally, an appendix affords a short note of the 
methods of preparation. 

"We would most cordially recommend it to all students of histology." — Dublin Medical 
Journal. 

" It is pleasant to give unqualified praise to the colored illustrations ; . . . the standard is 
high, and many of them are not only extremely beautiful, but very clear and demonstra- 
tive. . . . The plan of the book is excellent." — Liverpool Medical Journal. 

ARCHIVES OF CLINICAL SKIAGRAPHY. By Sydney Rowland, 
B. A., Camb. A series of collotype illustrations, with descriptive text, 
illustrating the applications of the New Photography to Medicine and Sur- 
gery. Price, per Part, $1.00. Parts I. to V. now ready. 

The object of this publication is to put on record in permanent form some of 
the most striking applications of the new photography to the needs of Medicine 
and Surgery. 

The progress of this new art has been so rapid that, although Prof. Rontgen's 
discovery is only a thing of yesterday, it has already taken its place among the 
approved and accepted aids to diagnosis. 

WATER AND WATER SUPPLIES. By John C. Thresh, D. Sc, 
M. B., D. P. H, Lecturer on Public Health, King's College, London ; 
Editor of the "Journal of State Medicine," etc. i2mo, 438 pages, illus- 
trated. Handsomely bound in Cloth, with gold side and back stamps. 
Price, $2.25 net. 

This work will furnish any one interested in public health the information 
requisite for forming an opinion as to whether any supply or proposed supply 
is sufficiently wholesome and abundant, and whether the cost can be considered 
reasonable. 

The work does not pretend to be a treatise on Engineering, yet it contains 
sufficient detail to enable any one who has studied it to consider intelligently any 
scheme which may be submitted for supplying a community with water. 



CATALOGUE OF MEDICAL WORKS. 15 

DISEASES OF THE EYE. A Hand-Book of Ophthalmic Prac- 
tice. By G. E. de Schweinitz, M. D., Professor of Ophthalmology in 
the Jefferson Medical College, Philadelphia, etc. A handsome royal- 
octavo volume of 679 pages, with 256 fine illustrations, many of which are 
original, and 2 chromo-lithographic plates. Prices: Cloth, $4.00 net; 
Sheep or Half-Morocco, $5.00 net. 

The object of this work is to present to the student, and to the practitioner 
who is beginning work in the fields of ophthalmology, a plain description of the 
optical defects and diseases of the eye. To this end special attention has been 
paid to the clinical side of the question; and the method of examination, the 
symptomatology leading to a diagnosis, and the treatment of the various ocular 
defects have been brought into prominence. 

THIRD EDITION, THOROUGHLY REVISED. 

The entire book has been thoroughly revised. In addition to this general 
revision, special paragraphs on the following new matter have been introduced : 
Filamentous Keratitis, Blood-staining of the Cornea, Essential Phthisis Bulbi, 
Foreign Bodies in the Lens, Circinate Retinitis, Symmetrical Changes at the 
Macula Lutea in Infancy, Hyaline Bodies in the Papilla, Monocular Diplopia, 
Subconjunctival Injections of Germicides, Infiltration-Anaesthesia, and Steriliza- 
tion of Collyria. Brief mention of Ophthalmia Nodosa, Electric Ophthalmia, 
and Angioid Streaks in the Retina also finds place. An Appendix has been 
added, containing a full description of the method of determining the corneal 
astigmatism with the ophthalmometer of Javal and Schiotz, and the rotations 
of the eyes with the tropometer of Stevens. The chapter on Operations has 
been enlarged and rewritten. 

"A clearly written, comprehensive manual. . . . One which we can commend to students 
as a reliable text-book, written with an evident knowledge of the wants of those entering upon 
the study of this special branch of medical science."— British Medical Journal. 

" The work is characterized by a lucidity of expression which leaves the reader in no 
doubt as to the meaning of the language employed. . . . We know of no work in which 
these diseases are dealt with more satisfactorily, and indications for treatment more clearly 
given, and in harmony with the practice of the most advanced ophthalmologists." — Mari- 
time Medical News. 

" It is hardly too much to say that for the student and practitioner beginning the study of 
Ophthalmology, it is the best single volume at present published."— Medical News. 

" The latest and one of the best books on Ophthalmology. The book is thoroughly up to 
date, and is certainly a work which not only commends itself to the student, but is a ready 
reference for the busy practitioner." — International Medical Review. 

PROFESSIONAL. OPINIONS. 

"A work that will meet the requirements not only of the specialist, but of the general 
practitioner in a rare degree. I am satisfied that unusual success awaits it." 

William Pepper, M. D. 
Provost and Professor of Theory and Practice of Medicine and Clinical Medicine 
in the University of Pennsylvania. 

" Contains in concise and reliable form the accepted views of Ophthalmic Science." 

William Thomson, M. D., 
Professor of Ophthalmology, Jefferson Medical College, Philadelphia, Pa. 



6 W. B. SAUNDERS' 



TEXT-BOOK UPON THE PATHOGENIC BACTERIA. Spe- 
cially written for Students of Medicine. By Joseph McFarland, 
M. D., Professor of Pathology and Bacteriology in the Medico-Chirurgical 
College of Philadelphia, etc. 497 pages, finely illustrated. Price, Cloth, 
$2.50 net. 

SECOND EDITION, REVISED AND GREATLY ENLARGED. 
The work is intended to be a text-book for the medical student and for the 
practitioner who has had no recent laboratory training in this department of medi- 
cal science. The instructions given as to needed apparatus, cultures, stairiings, 
microscopic examinations, etc. are ample for the student's needs, and will afford 
to the physician much information that will interest and profit him relative to a 
subject which modern science shows to go far in explaining the etiology of many 
diseased conditions. 

In this second edition the work has been brought up to date in all depart- 
ments of the subject, and numerous additions have been made to the technique 
in the endeavor to make the book fulfil the double purpose of a systematic worf 
upon bacteria and a laboratory guide. 

" It is excellently adapted for the medical students and practitioners for whom it is avowedly 
written. . . . The descriptions given are accurate and readable, and the book should prove 
useful to those for whom it is written. — London Lancet, Aug. 29, 1896. 

" The author has succeded admirably in presenting the essential details of bacteriological 
technics, together with a judiciously chosen summary of our present knowledge of pathogenic 
bacteria. . . . The work, we think, should have a wide circulation among English-speaking 
students of medicine." — N. Y. Medical Journal, April 4, 1896. 

" The book will be found of considerable use by medical men who have not had a special 
bacteriological training, and who desire to understand this important branch of medical 
science." — Edinburgh Medical Journal, July, 1896. 

LABORATORY GUIDE FOR THE BACTERIOLOGIST. By 

Langdon Frothingham, M. D. V., Assistant in Bacteriology and Veteri- 
nary Science, Sheffield Scientific School, Yale University. Illustrated. 
Price, Cloth, 75 cents. 

The technical methods involved in bacteria-culture, methods of staining, and 
microscopical study are fully described and arranged as simply and concisely as 
possible. The book is especially intended for use in laboratory work 

" It is a convenient and useful little work, and will more than repay the outlay necessary 
for its purchase in the saving of time which would otherwise be consumed in looking up the 
various points of technique so clearly and concisely laid down in its pages." — American Med.- 
Surg. Bulletin. 

FEEDING IN EARLY INFANCY. By Arthur V. Meigs, M. D. 
Bound in limp cloth, flush edges. Price, 25 cents net. 

Synopsis : Analyses of Milk — Importance of the Subject of Feeding in Early 
Infancy — Proportion of Casein and Sugar in Human Milk — Time to Begin Arti- 
ficial Feeding of Infants — Amount of Food to be Administered at Each Feed- 
ing — Intervals between Feedings — Increase in Amount of Food at Different 
Periods of Infant Development — Unsuitableness of Condensed Milk as a Sub- 
stitute for Mother's Milk — Objections to Sterilization or " Pasteurization " of 
Milk— Advances made in the Method of Artificial Feeding of Infants. 



CATALOGUE OF MEDICAL WORKS. 17 



ESSENTIALS OF ANATOMY AND MANUAL OF PRACTI- 
CAL DISSECTION, containing " Hints on Dissection." By Charles 
B. Nancrede, M. D., Professor of Surgery and Clinical Surgery in the 
University of Michigan, Ann Arbor; Corresponding Member of the Royal 
Academy of Medicine, Rome, Italy ; late Surgeon Jefferson Medical Col- 
lege, etc. Fourth and revised edition. Post 8vo, over 500 pages, with 
handsome full-page lithographic plates in colors, and over 200 illustrations. 
Price : Extra Cloth or Oilcloth for the dissection-room, #2.00 net. 

Neither pains nor expense has been spared to make this work the most ex- 
haustive yet concise Student's Manual of Anatomy and Dissection ever pub- 
,cl> ed, either in America or in Europe. 

The colored plates are designed to aid the student in dissecting the muscles, 

.rteries, veins, and nerves. The wood-cuts have all been specially drawn and 

engraved, and an Appendix added containing 60 illustrations representing the 

ructure of the entire human skeleton, the whole being based on the eleventh 

edition of Gray's Anatomy, 

" The plates are of more than ordinary excellence, and are of especial value to students in 
their work in the dissecting-room."— Journal of American Medical Association. 

" Should be in the hands of every medical student."— Cleveland Medical Gazette. 

" A concise and judicious work."— Buffalo Medical and Surgical Journal. 

A MANUAL OF PRACTICE OF MEDICINE. By A. A. Stevens, 
A. M., M. D., Instructor of Physical Diagnosis in the University of Penn- 
sylvania, and Demonstrator of Pathology in the Woman's Medical College 
of Philadelphia. Specially intended for students preparing for graduation 
and hospital examinations, and includes the following sections : General 
Diseases, Diseases of the Digestive Organs, Diseases of the Respiratory 
System, Diseases of the Circulatory System, Diseases of the Nervous Sys- 
tem, Diseases of the Blood, Diseases of the Kidneys, and Diseases of the 
Skin. Each section is prefaced by a chapter on General Symptomatology. 
Post Svo, 520 pages. Numerous illustrations and selected formulae. 
Price, $2.50, bound in flexible leather. 

FIFTH EDITION, REVISED AND ENLARGED. 

Contributions to the science of medicine have poured in so rapidly during the 
last quarter of a century that it is well-nigh impossible for the student, with the 
limited time at his disposal, to master elaborate treatises or to cull from them 
that knowledge which is absolutely essential. From an extended experience in 
teaching, the author has been enabled, by classification, to group allied symp- 
toms, and by the judicious elimination of theories and redundant explanations 
to bring within a comparatively small compass a complete outline of the prac- 
tice of medicine. 



1 8 W. B. SAUNDERS 



MANUAL OF MATERIA MEDICA AND THERAPEUTICS. 

By A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the 
University of Pennsylvania, and Demonstrator of Pathology in the Woman's 
Medical College of Philadelphia. 445 pages. Price, Cloth, #2.25. 

a SECOND EDITION, REVISED. 

This wholly new volume, which is based on the last edition of the Pharma- 
copoeia, comprehends the following sections: Physiological Action of Drugs; 
Drugs ; Remedial Measures other than Drugs ; Applied Therapeutics ; Incom- 
patibility in Prescriptions ; Table of Doses ; Index of Drugs ; and Index of 
Diseases ; the treatment being elucidated by more than two hundred formulae. 

"The author is to be congratulated upon having presented the medical student with as 
accurate a manual of therapeutics as it is possible to prepare."— Therapeutic Gazette. 

" Far superior to most of its class ; in fact, it is very good. Moreover, the book is reliable 
and accurate." — New York Medical Journal. 

" The author has faithfully presented modern therapeutics in a comprehensive work, . . . 
and it will be found a reliable guide."— University Medical Magazine. 



NOTES ON THE NEWER REMEDIES: their Therapeutic Ap- 
plications and Modes of Administration. By David Cerna, M. D., 
Ph. D., Demonstrator of and Lecturer on Experimental Therapeutics in 
the University of Pennsylvania. Post-octavo, 253 pages. Price, #1.25. 

SECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED. 

The work takes up in alphabetical order all the newer remedies, giving their 
physical properties, solubility, therapeutic applications, administration, and 
chemical formula. 

It thus forms a very valuable addition to the various works on therapeutics 
now in existence. 

Chemists are so multiplying compounds, that,, if each compound is to be thor- 
oughly studied, investigations must be carried far enough to determine the prac- 
tical importance of the new agents. 

" Especially valuable because of its completeness, its accuracy, its systematic consider- 
ation of the properties and therapy of many remedies of which doctors generally know but 
little, expressed in a brief yet terse manner." — Chicago Clinical Review. 



TEMPERATURE CHART. Prepared by D. T. Laine, M. D. Size 
8x 13^ inches. Price, per pad of 25 charts, 50 cents. 

A conveniently arranged chart for recording Temperature, with columns for 
daily amounts of Urinary and Fecal Excretions, Food, Remarks, etc. On the 
back of each chart is given in full the method of Brand in the treatment of 
Typhoid Fever. 



CATALOGUE OF MEDICAL WORKS. 1 9 

SAUNDERS' POCKET MEDICAL LEXICON; or, Dictionary of 
Terms and Words used in Medicine and Surgery. By John M. 
Keating, M. D., editor of " Cyclopaedia of Diseases of Children," etc. ; 
author of the " New Pronouncing Dictionary of Medicine;" and Henrv 
Hamilton, author of " A New Translation of Virgil's yEneid into Eng- 
lish Verse;" co-author of a " New Pronouncing Dictionary of Medicine." 
A new and revised edition. 32mo, 282 pages. Prices: Cloth, 75 cents s * 
Leather Tucks, $1.00. 

This new and comprehensive work of reference is the outcome of a demand 
for a more modern handbook of its class than those at present on the market, 
which, dating as they do from 1855 to 1884, are of but trifling use to the student 
by their not containing the hundreds of new words now used in current litera- 
ture, especially those relating to Electricity and Bacteriology. 

" Remarkably accurate in terminology, accentuation, and definition." — Journal of Amer~ 
ican Medical Association. 

" Brief, yet complete .... it contains the very latest nomenclature in even the newest 
departments of medicine." — New York Medical Record. 



SAUNDERS' POCKET MEDICAL FORMULARY. By William 
M. Powell, M. D., Attending Physician to the Mercer House for Invalid 
Women at Atlantic City. Containing 1800 Formulae, selected from several 
hundred of the best-known authorities. Forming a handsome and con- 
venient pocket companion of nearly 300 printed pages, with blank leaves 
for Additions; with an Appendix containing Posological Table, Formulae 
and Doses for Hypodermatic Medication, Poisons and their Antidotes, 
Diameters of the Pemale Pelvis and Foetal Head, Obstetrical Table, Diet 
List for Various Diseases, Materials and Drugs used in Antiseptic Surgery, 
Treatment of Asphyxia from Drowning, Surgical Remembrancer, Tables 
of Incompatibles, Eruptive Fevers, Weights and Measures, etc. Fourth 
edition, revised and greatly enlarged. Handsomely bound in morocco, 
with side index, wallet, and flap. Price, $1.75 net. 

A concise, clear, and correct record of the many hundreds of famous formulae 
which are found scattered through the works of the most eminent physicians 
and surgeons of the world. The work is helpful to the student and practitioner 
alike, as through it they become acquainted with numerous formulae which are 
not found in text-books, but have been collected from among the rising genera- 
tion of the profession, college professors, and hospital physicians and surgeons. 

"This little book, that can be conveniently carried in the pocket, contains an immense 
amount of material. It is very useful, and as the name of the author of each prescription is 
given is unusually reliable." — New York Medical Record. 

" Designed to be of immense help to the general practitioner in the exercise of his daily 
calling." — Boston Medical and Surgical Journal. 



20 W. B. SAUNDERS' 



DISEASES OF WOMEN. By Henry J. Garrigues, A.M., M. D., 
Professor of Gynecology and Obstetrics in the New York School of Clinical 
Medicine ; Gynecologist to St. Mark's Hospital and to the German Dis- 
pensary, New York City. In one handsome octavo volume of 728 pages, 
illustrated by 335 engravings and colored plates. Prices : Cloth, $4.00 net ; 
Sheep or Half Morocco, $5.00 net. 

A PRACTICAL work on gynecology for the use of students and practitioners, 
written in a terse and concise manner. The importance of a thorough know- 
ledge of the anatomy of the female pelvic organs has been fully recognized by 
the author, and considerable space has been devoted to the subject. The chap- 
ters on Operations and on Treatment are thoroughly modern, and are based 
upon the large hospital and private practice of the author. The text is eluci- 
dated by a large number of illustrations and colored plates, many of them being 
original, and forming a complete atlas for studying embryology and the anatomy 
of the female genitalia, besides exemplifying, whenever needed, morbid condi- 
tions, instruments, apparatus, and operations. 

Second Edition, Thoroughly Revised. 

The first edition of this work met with a most appreciative reception by the 
medical press and profession both in this country and abroad, and was adopted 
as a text-book or recommended as a book of reference by nearly one hundred 
colleges in the United States and Canada. The author has availed himself of 
the opportunity afforded by this revision to embody the latest approved advances 
in the treatment employed in this important branch of Medicine. He has also 
more extensively expressed his own opinion on the comparative value of the 
different methods of treatment employed. 

"One of the best text-books for students and practitioners which has been published in 
the English language ; it is condensed, clear, and comprehensive. The profound learning 
and great clinical experience of the distinguished author find expression in this book in a 
most attractive and instructive form. Young practitioners, to whom experienced consultants 
may not be available, will find in this book invaluable counsel and help." 

Thad. A. Reamy, M. D., LL.D., 
Professor of Clinical Gynecology, Medical College of Ohio ; Gynecologist to the Good 
Samaritan and Cincinnati Hospitals. 



A SYLLABUS OF GYNECOLOGY, arranged in conformity witn 
"An American Text-Book of Gynecology." By J. W. Long, M. D., 
Professor of Diseases of Women and Children, Medical College of Vir- 
ginia, etc. Price, Cloth (interleaved), $1.00 net. 

Based upon the teaching and methods laid down in the larger work, this will 
not only be useful as a supplementary volume, but to those who do not already 
possess the text-book it will also have an independent value as an aid to the 
practitioner in gynecological work, and to the student as a guide in the lecture- 
room, as the subject is presented in a manner at once systematic, clear, succinct, 
paid practical. 



CATALOGUE OF MEDICAL WORKS. 



A MANUAL OF PHYSIOLOGY, with Practical Exercises. For 

Students and Practitioners. By G. N. Stewart, M. A., M. D., D. Sc, 

lately Examiner in Physiology, University of Aberdeen, and of the New 

Museums, Cambridge University ; Professor of Physiology in the Western 

Reserve University, Cleveland, Ohio. Handsome octavo volume of 800 

pages, with 278 illustrations in the text, and 5 colored plates. Price, 

Cloth, $3.50 net. 

" It will make its way by sheer force of merit, and amply deserves to do so. It is one oj 
the very best English text-books on the subject." — London Lancet. 

" Of the many text-books of physiology published, we do not know of one that so nearly 
comes up to the ideal as does Professor Stewart's volume." — British Medical Journal. 

ESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THORAX. 

By Arthur M. Corwin, A. M., M. D., Demonstrator of Physical Diagno- 
sis in the Rush Medical College, Chicago ; Attending Physician to the 
Central Free Dispensary, Department of Rhinology, Laryngology, and 
Diseases of the Chest. 200 pages. Illustrated. Cloth, flexible covers. 
Price, #1.25 net. 

SYLLABUS OF OBSTETRICAL LECTURES in the Medical 
Department, University of Pennsylvania. By Richard C. Norris, 
A. M., M. D., Lecturer on Clinical and Operative Obstetrics, University 
of Pennsylvania. Third edition, thoroughly revised and enlarged. Crown 
8vo. Price, Cloth, interleaved for notes, $2.00 net. 

" This work is so far superior to others on the same subject that we take pleasure in call- 
ing attention briefly to its excellent features. It covers the subject thoroughly, and will 
prove invaluable both to the student and the practitioner. The author has introduced a 
number of valuable hints which would only occur to one who was himself an experienced 
teacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially 
pleased with the portion devoted to the practical duties of the accoucheur, care of the child, 
etc. The paragraphs on antiseptics are admirable; there is no doubtful tone in the direc- 
tions given. No details are regarded as unimportant ; no minor matters omitted. We ven- 
ture to say that even the old practitioner will find useful hints in this direction which he can- 
not afford to despise." — New York Medical Record. 

A SYLLABUS OF LECTURES ON THE PRACTICE OF SUR- 
GERY, arranged in conformity with " An American Text-Book 
of Surgery." By N. Senn, M. D., Ph. D., Professor of Surgery in Rush 
Medical College, Chicago, and in the Chicago Polyclinic. Price, $2.00. 

This, the latest work of its eminent author, himself one of the contributors 
to " An American Text-Book of Surgery," will prove of exceptional value to 
the advanced student who has adopted that work as his text-book. It is not 
only the syllabus of an unrivalled course of surgical practice, but it is also an 
epitome of or supplement to the larger work. 

" The author has evidently spared no pains in making his Syllabus thoroughly comprehen- 
sive, and has added new matter and alluded to the most recent authors and operations. Full 
references are also given to all requisite details of surgical anatomy and pathology."— British 
Medical Journal, London. 



22 W, B< SAUNDERS' 



AN OPERATION BLANK, with Lists of Instruments, etc. re- 
quired in Various Operations. Prepared by W. W. Keen, M. D., 
LL.D., Professor of Principles of Surgery in the Jefferson Medical Col- 
lege, Philadelphia. Price per Pad, containing Blanks for fifty operations, 
50 cents net. 

SECOND EDITION, REVISED FORM. 

A convenient blank, suitable for all operations, giving complete instructions 
regarding necessary preparation of patient, etc., with a full list of dressings and 
medicines to be employed. 

On the back of each blank is a list of instruments used — viz. general instru- 
ments, etc., required for all operations ; and special instruments for surgery of 
the brain and spine, mouth and throat, abdomen, rectum, male and female 
genito-urinary organs, the bones, etc. 

The whole forming a neat pad, arranged for hanging on the wall of a sur- 
geon's office or in the hospital operating-room. 

" Will serve a useful purpose for the surgeon in reminding him of the details of prepa- 
ration for the patient and the room as well as for the instruments, dressings, and antiseptics 
needed " — New York Medical Record 

" Covers about all that can be needed in any operation." — American Lancet. 

" The plan is a capital one."— Boston Medical and Surgical Journal. 

LABORATORY EXERCISES IN BOTANY. By Edson S. Bastin, 
M. A., Professor of Materia Medica and Botany in the Philadelphia Col- 
lege of Pharmacy. Octavo volume of 536 pages, 87 full-page plates. Price, 
Cloth, $2.50. 

This work is intended for the beginner and the advanced student, and it fully 
covers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers, 
bulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross 
and microscopical structure of plants, and to those used in medicine. Illustra- 
tions have freely been used to elucidate the text, and a complete index to facil- 
itate reference has been added. 

" There is no work like it in the pharmaceutical or botanical literature of this country, and 
we predict for it a wide circulation." — American Journal of Pharmacy. 

DIET IN SICKNESS AND IN HEALTH. By Mrs. Ernest Hart, 
formerly Student of the Faculty of Medicine of Paris and of the London 
School of Medicine for Women ; with an Introduction by Sir Henry 
Thompson, F. R. C. S., M. D., London. 220 pages; illustrated. Price, 
Cloth, $1.50. 

Useful to those who have to nurse, feed, and prescribe for the sick. In 
each case the accepted causation of the disease and the reasons for the special 
diet prescribed are briefly described. Medical men will find the dietaries and 
recipes practically useful, and likely to save them trouble in directing the dietetic 
treatment of patients. 



CATALOGUE OF MEDICAL WORKS. 23 

HOW TO EXAMINE FOR LIFE INSURANCE. By John M. 
Keating, M. D., Fellow of the College of Physicians and Surgeons of 
Philadelphia; Vice-President of the American Pediatric Society; Ex- 
President of the Association of Life Insurance Medical Directors. Royal 
8vo, 211 pages, with two large half-tone illustrations, and a plate prepared 
by Dr. McClellan from special dissections ; also, numerous cuts to elucidate 
the text. Second edition. Price, Cloth, $2.00 net. 

" This is by far the most useful book which has yet appeared on insurance examination, a 
subject of growing interest and importance. Not the least valuable portion of the volume is 
Part II., which consists of instructions issued to their examining physioians by twenty-four 
representative companies of this country. As the proofs of these instructions were corrected 
by the directors of the companies, they form the latest instructions obtainable. If for these 
alone, the book should be at the right hand of every physician interested in this special branch 
of medical science." — The Medical News, Philadelphia. 

NURSING: ITS PRINCIPLES AND PRACTICE. By Isabel 
Adams Hampton, Graduate of the New York Training School for 
Nurses attached to Bellevue Hospital; Superintendent of Nurses and 
Principal of the Training School for Nurses, Johns Hopkins Hospital, 
Baltimore, Md. ; late Superintendent of Nurses, Illinois Training School 
for Nurses, Chicago, 111. In one very handsome i2mo volume of 484 
pages, profusely illustrated. Price, Cloth, $2.00 net. 

This original work on the important subject of nursing is at once comprehensive 
and systematic. It is written in a clear, accurate, and readable style, suitable 
alike to the student and the lay reader. Such a work has long been a desidera- 
tum with those entrusted with the management of hospitals and the instruction of 
nurses in training-schools. It is also of especial value to the graduated nurse 
who desires to acquire a practical working knowledge of the care of the sick 
and the hygiene of the sick-room. 

OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA- 
TIONS. By L. Ch. Boisliniere, M. D., late Emeritus Professor of 
Obstetrics in the St. Louis Medical College. 381 pages, handsomely illus- 
trated. Price, $2.00 net. 

" For the use of the practitioner who, when away from home, has not the 
opportunity of consulting a library or of calling a friend in consultation. He 
then, being thrown upon his own resources, will find this book of benefit in 
guiding and assisting him in emergencies." 

INFANT'S WEIGHT CHART. Designed by J. P. Crozer Griffith, 
M. D., Clinical Professor of Diseases of Children in the University of Penn- 
sylvania. 25 charts in each pad. Price per pad, 50 cents net. 

A convenient blank for keeping a record of the child's weight during the first 
two years of life. Printed on each chart is a curve representing the average weight 
of a healthy infant, so that any deviation from the normal can readily be detected. 



24 W. B. SAUNDERS' 

THE CARE OF THE BABY. By J. P. Crozer Griffith, M. D, 
Clinical Professor of Diseases of Children, University of Pennsylvania; 
Physician to the Children's Hospital, Philadelphia, etc. 404 pages, with 
67 illustrations in the text, and 5 plates. 121110. Price, #1.50. 

SECOND EDITION, REVISED. 

A reliable guide not only for mothers, but also for medical students and 
practitioners whose opportunities for observing children have been limited. 

" The whole book is characterized by rare good sense, and is evidently written by a mas- 
ter hand. It can be read with benefit not only by mothers, but by medical students and by 
any practitioners who have not had large opportunities for observing children."— American 
Jjurnal of Obstetrics. 

THE NURSE'S DICTIONARY of Medical Terms and Nursing 
Treatment, containing Definitions of the Principal Medical and Nursing 
Terms, Abbreviations, and Physiological Names, and Descriptions of the 
Instruments, Drugs, Diseases, Accidents, Treatments, Operations, Foods, 
Appliances, etc. encountered in the ward or the sick-room. By Honnor 
Morten, author of " How to Become a Nurse," " Sketches of Hospital 
Life," etc. i6mo, 140 pages. Price, Cloth, $1.00. 

This little volume is intended for use merely as a small reference-book which 
can be consulted at the bedside or in the ward. It gives sufficient explanation 
to the nurse to enable her to comprehend a case until she has leisure to look up 
larger and fuller works on the subject. 

DIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas, 
M. D., Visiting Physicia-n to the Home for Friendless Women and Children 
and to the Newsboys' Home ; Assistant Visiting Physician to the Kings 
County Hospital; Assistant Bacteriologist, Brooklyn Health Department. 
Price, Cloth, $1.50 (Send for specimen List.) 

One hundred and sixty detachable (perforated) diet lists for Albuminuria, 
Anaemia and Debility, Constipation, Diabetes, Diarrhoea, Dyspepsia, Fevers, 
Gout or Uric-Acid Diathesis, Obesity, and Tuberculosis. Also forty detachable 
sheets of Sick-Room Dietary, containing full instructions for preparation of 
easily-digested foods necessary for invalids. Each list is numbered only, the 
disease for which it is to be used in no case being mentioned, an index key 
being reserved for the physician's private use. 

DIETS FOR INFANTS AND CHILDREN IN HEALTH AND 
IN DISEASE. By Louis Starr, M. D., Editor of " An American 
Text-Book of the Diseases of Children." 230 blanks (pocket-book size), 
perforated and neatly bound in flexible morocco. Price, #1.25 net. 

The first series of blanks are prepared for the first seven months of infant 
life ; each blank indicates the ingredients, but not the quantities, of the food, 
the latter directions being left for the physician. After the seventh month, 
modifications being less necessary, the diet lists are printed in full. Formula 
ioi trie preparation of diluents and foods are appended. 




saunders' 
New Series 
of Manuals 



for Students 
and 
Practitioners* 



THAT there exists a need for thoroughly reliable hand-books on the leading 
branches of Medicine and Surgery is a fact amply demonstrated by the 
favor with which the SAUNDERS NEW SERIES OF MANUALS have been 
received by medical students and practitioners and by the Medical Press. 
These manuals are not merely condensations from present literature, but 
are ably written by well-known authors and practitioners, most of them being 
teachers in representative American colleges. Each volume is concisely and 
authoritatively written and exhaustive in detail, without being encumbered 
with the introduction of "cases," which so largely expand the ordinary text- 
book. These manuals will therefore form an admirable collection of advanced 
lectures, useful alike to the medical student and the practitioner : to the latter, 
too busy to search through page after page of elaborate treatises for what he 
wants to know, they will prove of inestimable value ; to the former they will 
afford safe guides to the essential points of study. 

The SAUNDERS NEW SERIES OF MANUALS are conceded to be 
superior to any similar books now on the market. No other manuals afford so 
much information in such a concise and available form. A liberal expenditure 
has enabled the publisher to render the mechanical portion of the work worthy 
of the high literary standard attained by these books. 

Any of these Manuals will be mailed on receipt of price (see next page 
for List). 

W, B. SAUNDERS, Publisher, 

925 Walnut Street, Philadelphia, 



SAUNDERS' NEW SERIES OF MANUALS. 



VOLUMES PUBLISHED. 



PHYSIOLOGY. By Joseph Howard Raymond, A. M., M. D., Professor 
of Physiology and Hygiene and Lecturer on Gynecology in the Long 
Island College Hospital, etc. Price, #1.25 net. 

SURGERY, General and Operative. By John Chalmers DaCosta, 
M. D„ Demonstrator of Surgery, Jefferson Medical College, Philadelphia, 
etc. Octavo, 911 pages, 386 illustrations. Cloth, $4.00 net; Half- 
Morocco, $5.00 net. 

DOSE-BOOK AND MANUAL OF PRESCRIPTION- WRITING. 

By E. Q. Thornton, M. D., Demonstrator of Therapeutics, Jefferson 
Medical College, Philadelphia. Price, #1.25 net. 

MEDICAL JURISPRUDENCE. By Henry C. Chapman, M. D., Pro- 
fessor of Institutes of Medicine and Medical Jurisprudence in the Jeffer- 
son Medical College of Philadelphia, etc Price, $1.50 net. 

SURGICAL ASEPSIS. By Carl Beck, M.D., Surgeon to St. Mark's 
Hospital and to the German Poliklinik ; Instructor in Surgery, New York 
Post-Graduate Medical School, etc. Price, $1.25 net. 

MANUAL OF ANATOMY. By Irving S. Haynes, M.D., Adjunct 
Professor of Anatomy and Demonstrator of Anatomy, Medical Department 
of the New York University, etc. (Double number.) Price, $2.50 net. 

SYPHILIS AND THE VENEREAL DISEASES. By James 
Nevins Hyde, M. D., Professor of Skin and Venereal Diseases, and 
Frank H. Montgomery, M. D., Lecturer on Dermatology and Genito- 
urinary Diseases, in Rush Medical College, Chicago. (Double number.) 
Price, #2.50 net. 

PRACTICE OF MEDICINE. By George Roe Lockwood, M. D., 
Professor of Practice in the Woman's Medical College of the New 
York Infirmary, etc. (Double number.) Price, $2.50 net. 

OBSTETRICS. By W. A. Newman Dorland, M. D., Asst. Demonstrator 
of Obstetrics, University of Pennsylvania ; Chief of Gynecological Dispen- 
sary, Pennsylvania Hospital. (Double number.) Price, $2.50 net. 

DISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant 
Surgeon to the Middlesex Hospital, and Surgeon to the Chelsea Hospital 
for Women, London; and Arthur E. Giles, M. D., B. Sc. Lond., 
F. R. C. S. Edin., Assistant Surgeon to the Chelsea Hospital for Women, 
London. 436 pages, handsomely illustrated. (Double number.) Price, 
$2.50 net. 

VOLUMES IN PREPARATION. 
NERVOUS DISEASES. By Charles W. Burr, M. D., Clinical Pro- 
fessor of Nervous Diseases, Medico-Chirurgical College, Philadelphia, etc. 

NOSE AND THROAT. By D. Braden Kyle, M. D., Clinical Professor 
of Laryngology and Rhinology, Jefferson Medical College, Philadelphia. 
*#* There will be published in the same series, at short intervals, carefully 
prepared works on various subjects, by prominent specialists. 



SAUNDERS' QUESTION COMPENDS. 

Arranged in Question and Answer Form, 

THE LATEST, MOST COMPLETE, and BEST ILLUSTRATED 
SEEIES OF COMPENDS EVEE ISSUED. 



Now the Standard Authorities in Medical Literature 



Students and Practitioners in every City of the United 
States and Canada. 



THE REASON WHY. 

They are the advance guard of " Student's Helps " — that DO help; they are 
the leaders in their special line, well and authoritatively written by able men, 
who, as teachers in the large colleges, know exactly what is wanted by a student 
preparing for his examinations. The judgment exercised in the selection of 
authors is fully demonstrated by their professional elevation. Chosen from the 
ranks of Demonstrators, Quiz-masters, and Assistants, most of them have be- 
come Professors and Lecturers in their respective colleges. 

Each book is of convenient size (5x7 inches), containing on an average 250 
pages, profusely illustrated, and elegantly printed in clear, readable type, on 
fine paper. 

The entire series, numbering twenty- four subjects, has been kept thoroughly 
revised and enlarged when necessaiy, many of them being in their fourth and 
fifth editions. 

TO SUM UP. 

Although there are numerous other Quizzes, Manuals, Aids, etc. in the mar- 
ket, none of them approach the " Blue Series of Question Compends;" and 
the claim is made for the following points of excellence : 

1. Professional distinction and reputation of authors. 

2. Conciseness, clearness, and soundness of treatment. 

3. Size of type and quality of paper and binding. 

*** Any of these Compends will be mailed on receipt of price (see over 
for List), 



SAUNDERS' QUESTION-COMPEND SERIES. 

Price, Cloth, $1.00 per copy, except when otherwise noted. 

1. ESSENTIALS OF PHYSIOLOGY. 3d edition. Illustrated. Re- 

vised and enlarged by H. A. Hare, M. D (Price, #1.00 net.) 

2. ESSENTIALS OF SURGERY. 6th edition, with an Appendix on 

Antiseptic Surgery. 90 illustrations. By Edward Martin, M. D. 

3. ESSENTIALS OF ANATOMY. 5th edition, with an Appendix. 180 

illustrations. By Charles B. Nancrede, M. D. 

4. ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND 

INORGANIC. 4th edition, revised, with an Appendix. By Law- 
rence Wolff, M. D. 

5. ESSENTIALS OF OBSTETRICS. 4th edition, revised and en- 

larged. 75 illustrations. By W. Easterly Ashton, M. D. 

6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. 

7th thousand. 46 illustrations. By C. E. Armand Semple, M. D. 

7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, 

AND PRESCRIPTION- WRITING. 4th edition. By Henry 
Morris, M. D. 

8. 9. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry 

Morris, M. D. An Appendix on Urine Examination. Illustrated. 
By Lawrence Wolff, M. D. 3d edition, enlarged by some 300 Es- 
sential Formulae, selected from eminent authorities, by Wm. M. Powell, 
M. D. (Double number, price $2.00.) 

10. ESSENTIALS OF GYNECOLOGY. 4th edition, revised. With 

62 illustrations. By Edwin B. Cragin, M. D. 

11. ESSENTIALS OF DISEASES OF THE SKIN. 3d edition, re- 

vised and enlarged. 71 letter-press cuts and 15 half-tone illustrations. 
By Henry W. Stelwagon, M. D. (Price, $1.00 net.) 

12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND 

VENEREAL DISEASES. 2d edition, revised and enlarged. 78 
illustrations. By Edward Martin, M. D. 

13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND 

HYGIENE. 130 illustrations. By C. E. Armand Semple, M. D. 

14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND 

THROAT. 124 illustrations. 2d edition, revised. By Edward 
Jackson, M. D., and E. Baldwin Gleason, M. D. 

15. ESSENTIALS OF DISEASES OF CHILDREN. Second edi 

tion. By William H. Powell, M. D. 
3. ESSENTIALS OF EXAMINATION OF URINE. Colored 
" Vogel Scale," and numerous illustrations. By Lawrence Wolff, 
M. D. (Price, 75 cents.) 

17. ESSENTIALS OF DIAGNOSIS. By S. Solis-Cohen, M. D., and 

A. A. Eshner, M. D. 55 illustrations, some in colors. (Price, $1.50 net.) 

18. ESSENTIALS OF PRACTICE OF PHARMACY. By L. E. 

Sayre. 2d edition, revised. 

20. ESSENTIALS OF BACTERIOLOGY. 3d edition. 82 illustra- 

tions. By M. V. Ball, M. D. 

21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. 

48 illustrations. 3d edition, revised. By John C. Shaw, M. D. 

22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d 

edition, revised. By Fred J. Brockway, M. D. (Price, $1.00 net.) 

23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations. 

By David D. Stewart, M. D., and Edward S. Lawrance, M. D. 

24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Gle\- 



RECENT PUBLICATIONS 



PENROSE'S DISEASES OF WOMEN 

A Text=Book of Diseases of Women. By Charles B. Penrose, M.D., Ph.D., 

Professor of Gynecology in the University of Pennsylvania; Surgeon to the Gynecean 
Hospital, Philadelphia. Octavo volume of 529 pages, handsomely illustrated. Cloth, 
$3.50 net. 

"I shall value very highly the copy of Penrose's "Diseases of Women " received. 
I have already recommended it to my class as the best book."— Howard A. Kelly, 
Professor of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Md. 

SENN'S GENITOURINARY TUBERCULOSIS 

Tuberculosis of the Genito=Urinary Organs, Male and Female. By Nicholas 
Senn, M.D., Ph.D., LL.D., Professor of the Practice of Surgery and of Clinical 
Surgery, Rush Medical College, Chicago. Handsome octavo volume of 320 pages, 
illustrated. Cloth, $3.00 net. 

SUTTON AND GILES' DISEASES OF WOMEN 

Diseases of Women. By J. Bland Sutton, F.R.C.S., Assistant Surgeon to Middle- 
sex Hospital, and Surgeon to Chelsea Hospital, London; and Arthur E. Giles, 
M.D., B.Sc. Lond., F R.C.S. Edin., Assistant Surgeon to Chelsea Hospital, London. 
436 pages, handsomely illustrated. Cloth, $2.50 ne t. 

BUTLER'S MATERIA MEDICA, THERAPEUTICS, AND PHAR= 
MACOLOGY. Second Edition, Revised 

A Text=Book of Materia Medica, Therapeutics, and Pharmacology. By George 
F. Butler, Ph.G., M.D., Professor of Materia Medica and of Clinical Medicine in 
the College of Physicians and Surgeons, Chicago ; Professor of Materia Medica and 
Therapeutics, Northwestern University, Woman's Medical School, etc. Octavo, 858 
pages, illustrated. Cloth, $4.00 net ; Sheep, $5.00 net. 

SAUNDBY'S RENAL AND URINARY DISEASES 

Lectures on Renal and Urinary Diseases. By Robert Saundby, M.D. Edin., 
Fellow of the Royal College of Physicians, London, and of the Royal Medico-Chirur- 
gical Society ; Physician to the General Hospital; Consulting Physician to the Eye 
Hospital and to the Hospital for Diseases of Women ; Professor of Medicine in Mason 
College, Birmingham, etc. Octavo volume of 434 pages, with numerous illustrations 
and 4 colored plates. Cloth, $2.50 net. 

PYE'S BANDAGING 

Elementary Bandaging and Surgical Dressing, with Directions Concerning 
the Immediate Treatment of Cases of Emergency. For the Use of Dressers 
and Nurses. By Walter Pye, F.R.C.S., Late Surgeon to St. Mary's Hospital, 
London. Small i2mo, with over 80 illustrations. Cloth, flexible covers. Price, 75 
cents net. 

MALLORY AND WRIGHT'S PATHOLOGICAL TECHNIQUE 

Pathological Technique. By Frank B. Mallory, A.M., M.D., Assistant Professor 
of Pathology, Harvard University Medical School ; and James H. Wright, A.M., 
M.D., Instructor in Pathology, Harvard University Medical School. Octavo volume 
of 396 pages, handsomely illustrated. Cloth, $2.50 net. 

" I have been looking forward to the publication of this book, and I am glad to say 
that I find it to be a most useful laboratory and post-mortem guide, full of practical infor- 
mation, and well up to date."— William H. Welch, Professor of Pathology, Johns 
Hopkins University, Baltimore, Md. 

ANDERS* PRACTICE OF MEDICINE. Second Edition 

A Text=Book of the Practice of Medicine. By James M. Anders, M.D., Ph.D., 
LL.D., Professor of the Practice of Medicine and of Clinical Medicine, Medico- 
Chirurgical College, Philadelphia. In one handsome octavo volume of 1287 pages, 
fully illustrated. Cloth, #5.50 net ; Sheep or Half Morocco, $6.50 net. 



ANOMALIES 

AND 

CURIOSITIES OF MEDICINE. 

BY 

GEORGE M. GOULD, M. D., and WALTER L. PYLE, M. D. 

Several years of exhaustive research have been spent by the authors in the 
great medical libraries of the United States and Europe in collecting the material 
for this work, fledical literature of all ages and all languages has 
been carefully searched, as a glance at the Bibliographic Index will show. Tha 
facts, which will be of extreme value to the author and lecturer, have 
been arranged and annotated, and full reference footnotes given, indicating 
whence they have been obtained. 

In view of the persistent and dominant interest in the anomalous and curious, 
a thorough and systematic collection of this kind (the first of which the 
authors have knowledge) must have its own peculiar sphere of usefulness. 

As a complete and authoritative Book of Reference it will be of value 
not only to members of the medical profession, but to all persons interested in 
general scientific, sociologic, and medico-legal topics ; in fact, the general inter- 
est of the subject and the dearth of any complete work upon it make this 
volume one of the most important literary innovations of the day. 

An especially valuable feature of the book consists of the Indexing. 
Besides a complete and comprehensive General Index, containing numerous 
cross-references to the subjects discussed, and the names of the authors of the 
more important reports, there is a convenient Bibliographic Index and a 
Table of Contents. 

The plan has been adopted of printing the topical headings in bold = 
face type, the reader being thereby enabled to tell at a glance the subject- 
matter of any particular paragraph or page. 

Illustrations have been freely employed throughout the work, there being 
165 relief cuts and 130 half-tones in the text, and 12 colored and half-tone full- 
page plates — a total of over 320 separate figures. 

The careful rendering of the text and references, the wealth of illustrations, 
the mechanical skill represented in the typography, the printing, and the bind- 
ing, combine to make this book one of the most attractive medical publications 
ever issued. 



Handsome Imperial Octavo Volume of 968 Pages. 
PRICES: Cloth, $6.00 net; Half Morocco, $7.00 net. 

3° 



JUST ISSUED 



AN AMERICAN TEXT=BOOK OF GENITOURINARY AND SKIN 
DISEASES 

Edited by L. Bolton Bangs, M.D., Late Professor of Genito-Urinary and Venereal 
Diseases, New York Post-Graduate Medical School and Hospital ; and William 
A. Hardaway, M.D., Professor of Diseases of the Skin, Missouri Medical College. 
Octavo volume of over 1200 pages, with 300 illustrations in the text, and 20 full-page 
colored plates. Prices: Cloth, $7.00 net ; Sheep or Half Morocco, $8.00 net. 

MOORE'S ORTHOPEDIC SURGERY 

A Manual of Orthopedic Surgery. By James E. Moore, M.D., Professor of Ortho- 
pedics and Adjunct Professor of Clinical Surgery, University of Minnesota, College 
of Medicine and Surgery. 8vo, 356 pages, handsomely illustrated. Cloth, $2.50 net. 

MACDONALD'S SURGICAL DIAGNOSIS AND TREATMENT 

Surgical Diagnosis and Treatment. By J. W. Macdonald, M.D. Edin., L.R.C.S. 
Edin., Professor of the Practice of Surgery and of Clinical Surgery in Hamline Uni- 
versity ; Visiting Surgeon to St. Barnabas' Hospital, Minneapolis, etc. Octavo 
volume of 800 pages, handsomely illustrated. Cloth, 55.00 net; Half Morocco, $6.00 net. 

CHAPIN ON INSANITY 

A Compendium of Insanity. By John B. Chapin, M.D., LL.D., Physician-in-Chief, 
Pennsylvania Hospital for the Insane; late Physician-Superintendent of the Willard 
State Hospital, New York, etc. i2mo., 234 pages, illustrated. Cloth, $1.25 net. 

KEEN ON THE SURGERY OF TYPHOID FEVER 

The Surgical Complications and Sequels of Typhoid Fever. By Wm. W. Keen, 
M.D., LL.D., Professor of the Principles of Surgery and of Clinical Surgery, Jeffer- 
son Medical College, Philada. Octavo volume of 400 pages. Cloth, $3.00 net. 

VAN VALZAH AND NISBET'S DISEASES OF THE STOMACH 

Diseases of the Stomach. By William W. van Valzah, M.D., Professor of General 
Medicine and Diseases of the Digestive System and the Blood, New York Polyclinic ; 
and J. Douglas Nisbet, M.D., Adjunct Professor of General Medicine and Diseases 
of the Digestive System and the Blood, New York Polyclinic. Octavo volume of 674 
pages, illustrated. Cloth, $3.50 net. 

IN PREPARATION 

AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE, EAR, 
NOSE, AND THROAT 

Edited by G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jefferson 
Medical College; and B. Alexander Randall, M.D., Professor of Diseases of the 
Ear in the University of Pennsylvania and in the Philadelphia Polyclinic. 

CHURCH AND PETERSON'S NERVOUS AND MENTAL DISEASES 

Nervous and Mental Diseases. By Archibald Church, M.D., Professor of Mental 
Diseases and Medical Jurisprudence, Northwestern University Medical School, 
Chicago; and Frederick Peterson, M.D. , Clinical Professor of Mental Diseases, 
Woman's Medical College, New York, etc. 

KYLE ON THE NOSE AND THROAT 

Diseases of the Nose and Throat. By D. Braden Kvle, M.D., Clinical Professor 
of Laryngology and Rhinology, Jefferson Medical College, Philadelphia ; Consulting 
Laryngologist, Rhinologist, and Otologist, St. Agnes' Hospital, etc. 

STENGEL'S PATHOLOGY 

A Manual of Pathology. By Alfred Stengel, MDi, Physician to the Philadel- 
phia Hospital; Professor of Clinical Medicine in the Woman's Medical College; 
Physician to the Children's Hospital, etc. 

HIRST'S OBSTETRICS 

A Text=Book of Obstetrics. By Barton Cooke Hirst, M.D., Professor of Ob 
stetrics, University of Pennsylvania. 

HEISLER'S EMBRYOLOGY 

A Text=Book of Embryology. By John C. Heisler, M.D., Professor of Anatomy, 
Medico-Chirurgical College, Philadelphia. 



s 



NOW KEADY, VOLUMES FOR 1896,1897,1898. 

s^tt:£t:d:e:r,s 7 

AMERICAN YEAR-BOOK OF MEDICINE and SURGERY, 

Edited by GEORGE M. GOULD, A. NL, M. D. 

Assisted by Eminent American Specialists and Teachers. 



n. 



s> • 

^ Notwithstanding the rapid multiplication of medical and surgical works, 

© still these publications fail to meet fully the requirements of the general physician^ 

^ inasmuch as he feels the need of something more than mere text-books of well- 

;* known principles of medical science. Mr. Saunders has long been impressed ^ 

,5 with this fact, which is confirmed by the unanimity of expression from the pro- *" 

8 fession at large, as indicated by advices from his large corps of canvassers. 

fcj This deficiency would best be met by current journalistic literature, but most >£ 

% practitioners have scant access to this almost unlimited source of information, <* 

» and the busy practiser has but little time to search out in periodicals the many <* 

g interesting cases whose study would doubtless be of inestimable value in his 5 

O practice. Therefore, a work which places before the physician in convenient k 

^ form an epitomization of this literature by persons competent to pronounce upon % 

§ . The Value of a Discovery or of a Method of Treatment ^. 

«> cannot but command his highest appreciation. It is this critical and judicial § 

.% function that will be assumed by the Editorial staff of the " American Year- 

^ Book of Medicine and Surgery." £? 

g It is the special purpose of the Editor, whose experience peculiarly qualifies «. 

8 him for the preparation of this work, not only to review the contributions to fcg 

Oi 

50 



American journals, but also the methods and discoveries reported in the leading § 

fe medical journals of Europe, thus enlarging the survey and making the work ^ 

» characteristically international. These reviews will not simply be a series of * 

§ undigested abstracts indiscriminately run together, nor will they be retrospective « 

£ of " news " one or two years old, but the treatment presented will be synthetic §?• 

^ and dogmatic, and will include only what is new. Moreover, through expert $ 

£ condensation by experienced writers these discussions will be 

Comprised in a Single Volume of about 1200 Pages. 
The work will be replete with original and selected illustrations skilfully 
reproduced, for the most part in Mr. Saunders' own studios established for the 
purpose, thus ensuring accuracy in delineation, affording efficient aids to a right 
comprehension of the text, and adding to the attractiveness of the volume. 
Prices : Cloth, $6.50 net; Half Morocco, $7.50 net. 

W. B. SAUNDERS, Publisher, 

925 Walnut Street, Philadelphia. 



